Adhesive capsulitis (AC) or frozen shoulder is an inflammatory condition characterized by joint stiffness and pain. Although its pathogenesis is not fully elucidated, inflammation (either acute or low-grade inflammation) is believed to play a crucial role. An increase in reactive oxygen and nitrogen species also occurs in AC. The management of AC is challenging for orthopedic surgeons and physical therapists. Intra-articular hyaluronate injection is a treatment option. Yet, failure is reported and may depend upon oxidative breakdown of hyaluronan. Adelmidrol is a palmitoylethanolamide analogue and azelaic acid derivative exerting antioxidant activity in a number of fibrotic disorders. Here we first report the in vitro ability of Adelmidrol to protect hyaluronan against oxidative degradation and to exert an antioxidant effect against hydrogen peroxide-induced increase in nitrite release and intracellular reactive oxygen species in the macrophage J774A.1 cell line. We then investigated a new intra-articular formulation of high molecular weight (1300-2000 kDa) hyaluronic acid (1%) and Adelmidrol (2%) in two AC patients partially responding to physical therapy. Within a tailored physical therapy approach, three fortnightly intra-articular injections of this formulation allowed for a progressive reduction in pain severity, as well as improved range of motion and daily living activities, with the good outcome being maintained at the six-month follow-up in both patients. Overall, the data show Adelmidrol's protective activity against hyaluronic acid oxidation and provide preliminary information for further studies to investigate the association of Adelmidrol and high molecular weight hyaluronic acid in the management of AC patients.
Introduction: Infected non-union of the tibial diaphysis is a refractory disease with high recurrence rates. It may be complicated by persistent local infection, bone and soft tissue loss and limb deformity. The masquelet technique is cost-effective in managing bone loss in the treatment of infected non-union. It does not require specialized training and sophisticated instruments. Case Report: A 16-year old female with recurrent discharging sinuses on the right leg following open reduction and internal fixation of a tibial shaft fracture. There were shortening, muscle atrophy, discharging sinuses on the anteromedial right leg and stiffness of the right ankle joint. Conclusion: Infected tibial shaft non-union may run a protracted course with reduced productivity and missed work. It may be refractory to multiple surgical procedures and result in limb deformity. Operative treatment of the disease with the masquelet technique could be safe, effective and applicable in a limited-resource setting. Additionally, the masquelet technique improves bone union and limb function. Staged surgical treatment, involving thorough debridement, maximises treatment success. The masquelet technique is a viable choice for the management of infected tibial shaft non-union and improves bone union and limb function. Tri-calcium phosphate augmentation of autograft in the treatment of large long bone defects increases graft volume and could promote bone union. Staged surgical treatment of infected tibial diaphyseal non-union maximises treatment success.
Reverse shoulder arthroplasty (RSA) utilizing uncemented humeral stems has emerged as a preferred approach for treating proximal humeral fractures (PHFs) at our institution. This retrospective study evaluated the functional and radiographic outcomes of 23 patients who underwent RSA with uncemented humeral stems for acute PHFs. Surgery was performed between January 2020 and February 2022 by two surgeons. Functional outcomes were assessed using the Constant Shoulder Score (CSS), while radiographic evaluation included assessment of tuberosity healing, notching, and humeral stem migration. Results showed satisfactory outcomes, with no instances of early loosening observed in the humeral stems. Patients demonstrated high levels of satisfaction and functional improvement postoperatively. The employment of uncemented humeral stems allows for precise insertion, contributing to favorable outcomes in acute PHFs treated with RSA.
Introduction: Intercondylar humerus fractures pose a challenge in treatment, historically favoring non-operative approaches due to poor outcomes. Recent advancements, including improved understanding of elbow biomechanics, surgical techniques, fixation devices, and rehabilitation protocols, have shifted the paradigm. While open reduction and internal fixation are considered the gold standard for young patients, elderly individuals with poor bone quality may benefit from primary total elbow arthroplasty as a viable treatment option.
Introduction: The Sacroiliac Joint (SIJ) can be an important and significant cause of low back pain. A dysfunctional SIJ is initially treated with conservative treatment options, although known to have limited effectiveness and durability. Therefore, surgical approaches such as minimally invasive sacroiliac joint fusion (MISJF) have emerged and outcomes appear to be promising in terms of pain reduction and improvement of self-reported mobility. To date, little is known about the effects of MISJF on balance and motion patterns reflective of daily life activities. Methods: A prospective, longitudinal study was conducted to analyze motion patterns in patients with postpartum SIJ dysfunction before and three months after MISJF, and compare these data with age-, BMI- and postpartum-matched controls. Motion was analyzed throughout the execution of three tasks; (1) normal gait, (2) alternated single leg stance (SLS), and (3) sit-to-stance (STS). Spatiotemporal parameters, center of pressure and mass, pelvic angles and other joint angels were measured using a twelvecamera, three-dimensional motion capture system and ground reaction force platforms. Results: Gait analysis revealed no improvement in any of the measured parameters when comparing pre- and postoperative. Patients had a shorter step and stride length and a slower walking speed compared to matched controls. During SLS, improvements in balance were observed after surgery in the patient group, reaching comparable values to the matched control group. Total execution time of an STS improved in patients following MISJF and was comparable to that of matched controls. Conclusion: This study suggests that motion patterns seem to improve after MISJF in patients with postpartum SIJ dysfunction. Most notable differences were an improved balance during SLS and a faster STS performance. Additional studies with longer follow-up and larger sample sizes should provide more detailed insights on motion analysis in patients with postpartum SIJ dysfunction following MISJF.
in Modulating Outcomes of Mild Knee Osteoarthritis: Multi-Centric, Randomized, Double-Blind, Placebo-Controlled Study
Purpose: The consequences of Anterior Cruciate Ligament (ACL) injury and subsequent reconstruction in handball players are understudied. The aim of the present study is to present the effects of ACL reconstruction exclusively on handball players regarding return to play. Methods: Fourteen knees with an ACL tear in twelve patients were included in the study. Nine injuries ( ) occurred during games, and five ( during training. The mechanism of injury was non-contact in of cases. All cases were treated with a hamstrings autograft. Results: The athletes returned to unrestricted full team training in a mean of 7.7 months. Return to competitive play was achieved in twelve of the fourteen cases ( in a mean time of 9.6 months post-operatively. Nine of the athletes that returned to play ( ) reached the same level of competition as before injury. At a mean follow-up of 37.1 months post-operatively, of the players included in the study and of those that returned to play were still active players; all playing at their pre-injury competition level. There was one recurrence of an ACL tear ( , while two athletes ( had a contralateral ACL rupture during the follow-up period. All athletes - including the ones that quitted - had excellent knee scores at the latest follow-up. IKDC mean score was 94.7 Lysholm mean score was 95 EuroQoL mean score was 100, and KOOS mean score was 97.3. Conclusions: A high proportion of elite handball players can return to play following ACL reconstruction with a low rate of recurrence. However, not all players can stay in the sport for long and this should be kept in mind when an ACL tear occurs.
Introduction: Conventional radiographs are not doing justice to the complexity of 3D hip pathologies.Some methods based on 3D technology did not find their way to clinical practice.The goal of this study was to develop a 3D measurement method (named spidermap) for the acetabular coverage that can be used for the diagnosis of DDH as well as for the quantification of correction after Periacetabular Osteotomy (PAO). Methods:In a first step we defined the threshold between physiological and dysplastic hips using this spidermap and in a second step we compared physiological to surgically treated dysplastic hips to quantify the correction.The population included three groups: Group A consisted of 18 physiological, group B of 21 dysplastic and group C of 8 surgically corrected hips.CT scans were used to calculate femoral head coverage by using the newly developed 3D algorithm.The result is a 2D map, a circular diagram showing anterior coverage at 0 °, lateral coverage at 90 °, posterior coverage at 180 ° and medial coverage at -90 °.In a first step, groups A and B were compared to determine in which areas there was a significant threshold regarding coverage.In a second step groups A and C were compared to quantify the surgical correction after PAO.Results: A significant threshold between groups A and B was found in the areas from -30 ° to 247.5 ° (p < 0.05).In the areas from 0 ° to 180 ° the specificity was high (>95%).The comparison of groups A and C showed a significant improvement in the areas from of 37 ° to 202.5 ° after PAO (p < 0.05). Conclusion:Our 3D measurement method was able to reliably distinguish between physiological und dysplastic hips which allows for diagnosis of DDH in three dimensions.Furthermore, the spidermap allows for assessment of successful correction after PAO.
Complications associated with advanced cancer pose a clinical challenge, particularly when bone metastases are involved, as they can worsen the prognosis and reduce the patient’s chances of survival. Solid tumors, such as those originating from the breast, prostate, and lungs, can potentially metastasize to bone. Mineralized bone matrices contain potent growth factors and cytokines. The bone microenvironment is distinctive, furnishing prolific soil for cancer cell proliferation. Following tumor-induced bone destruction by osteoclast, the Transforming Growth Factor (TGFβ) is released from the mineralized bone matrix. It is one of the most abundant growth factors released from the bone matrix. TGFβ stimulates tumor cell secretion of factors that accelerate bone resorption and stimulate tumor cell colonization. Consequently, TGFβ is essential for fueling cancer’s vicious cycle of cancer growth and bone destruction. In addition, TGFβ promotes Epithelial-Mesenchymal Transition (EMT), increasing cell invasiveness, angiogenesis, and metastasis progression. Emerging evidence demonstrates that TGFβ inhibits immune responses, allowing opportunistic cancer cells to evade immune checkpoints and promote bone metastasis. By inhibiting TGFβ signaling pathways, cancer progression in the bone could be broken, EMT could be reversed, and immune response could be improved. However, the dual function of TGFβ as both a tumor suppressor and an enhancer pose a formidable obstacle to developing therapeutics that target TGFβ signaling. This review delves into the significance of TGFβ in the advancement of cancer and bone metastases, in addition to examining the current therapeutic prospects of TGFβ pathway targeting.
Purpose: The purpose of this study is to search for the biomechanical behavior of the Medial Patellofemoral Ligament (MPFL) after the patellar and femoral insertions were artificially equalized to the same width. Methods: Thirty-eight knees were obtained from 19 male cadavers. After careful dissection of the MPFL, the medial third of the patella was sawn off longitudinally, as well as the ligament’s femoral insertion, creating a bone–ligament–bone unit. Then, a transverse cut was made in the patellar ligament insertion until its patellar width matched that of the femoral insertion. This cut was made proximal in the right knee and distal in the left. Each unit was then submitted to a traction test using the same protocol and method. Results: Prior to the test, the ligament was measured, and three zones were established: proximal, from the patellar insertion up to 33% of the total length; medial, 37–66%; and distal, 67–100%. Of the 38 ligaments submitted to the traction test, five ruptured in the proximal segment (13.1%), eight (21%) ruptured in the distal segment, and 25 (65%) ruptured in the medial portion, with the proximal transverse cut having no statistical influence on the ligament rupture pattern. Conclusion: The wider patellar than femoral insertion of the MPFL has little to do with its strength and probably much more to do with the vastus medialis expansion.
Purpose: To determine the effects of a post-free distraction technique compared to a peroneal post cohort undergoing hip arthroscopy on pain and narcotic use during the acute post-operative phase.Methods: Patients who underwent hip arthroscopy for Femoroacetabular Impingement Syndrome (FAIS) within two months before and immediately after the introduction of post-free distraction were identified through our multicenter database.Post Anesthesia Care Unit (PACU) Visual Analog Scale (VAS) Maximum score, VAS on initial presentation to the PACU (VAS Initial), VAS at discharge, and PACU opioid consumption were extracted from the database.Results: A total of 82 patients met the inclusion criteria (41 post-free distraction and 41 peroneal post distraction).Mean VAS Initial score for the post group was 5.4 ± 2.8, the post-free group was 4.5 ± 2.5, P -value = 0.16.Mean VAS Max score for the post group was 7.0 ± 2.1, the Post-free group was 5.7 ± 2.2, P -value 0.006.Mean VAS for the post group was 5.6 ± 2.6, the post-free was 4.7 ± 2.4, P-value = 0.004 (Figure 1).ME for the post group was 17.5 ± 11.0 while the post-free group was 15.4 ± 10.2, P -value 0.33. Conclusions:Our post-free cohort showed similar demographics, surgical time, ME given and procedures performed to the peroneal post cohort, and the only variable changed was removal of the post.We found that the immediate response to removing the post was significantly decreased maximum and mean PACU pain.With the removal of the peroneal post, although not significant, we identified a decrease trend in narcotic use in the post-free group.Clinical Relevance: Implementing a post-free traction technique may demonstrate decreased postoperative pain and opioid use in patients undergoing hip arthroscopy and thus may reduce postoperative complications such as pudendal nerve injury.
Objective: There is limited knowledge on the level of dietary intake of Saturated Fatty Acids (SFA) and Trans Fatty Acids (TFA) and physical activity of patients with Knee Osteoarthritis (OA).In this study, we monitored and compared the level of SFA and TFA dietary intake, and physical activity in adults with and without knee OA.We also investigate the relationship between nutrient intake and physical activity with OA symptoms.Design/Setting/Participants: Sixty patients diagnosed with knee OA and 50 healthy subjects were recruited in this crosssectional study.Nutrient intakes were collected using a 3-day dietary record, and number of steps was monitored using Fitbit device.The clinical diagnosis was assessed using performance-based measures of 6-minute walk (6MWT) and stair test, and self-reported measures of pain, stiffness, and function.Results: Patients had fewer steps/day (p=0.04) and spent less time in very active movements (p=0.02)than healthy controls.When nutrient intake was adjusted for sex, Body Mass Index (BMI), and age, patients with OA had significantly (p<0.01)higher intake of SFA, and TFA than healthy controls.Steps/day had a significant (p<0.01)association with all self-reported and performance-based measures.SFA was significantly (p<0.05)associated with pain, stiffness, and 6MWT, and TFA was significantly (p<0.05)associated with pain, function score, and 6MWT. Conclusion:Walking more and consuming lower amount of SFA and TFA were associated with lower pain and higher physical function scores.Increasing walking, and reducing SFA and TFA should be explored as potential interventions for patients with knee OA.
We evaluated the efficacy and safety of FlexPro MD ® (FP-MD), a combination of krill oil, astaxanthin, and hyaluronic acid, in adults with non-arthritic knee joint pain.This multicenter, double-blind, placebo-and active-controlled study randomized 140 adults 1:1:1 to oral glucosamine hydrochloride/chondroitin sulfate (GC), FP-MD, or placebo once daily for 8 weeks.Mean percentage decreases in clinician-rated WOMAC pain scores were 35% (FP-MD), 21 % (GC), and 20% (placebo) at week 2, and 55% (FP-MD), 35% (GC), and 30% (placebo) at week 8. Overall, the mean percentage decrease in pain was significantly greater (P<0.0001) for FP-MD than for either GC or placebo subjects.FP-MD subjects experienced significantly greater reductions in WOMAC pain scores compared with GC (P=0.004) and placebo (P=0.011) at week 8 (post-hoc pairwise comparisons).Reductions in patient-reported VAS pain scores followed a similar pattern.FP-MD was three times more effective than GC for pain reduction (63% of FP-MD vs. 16% of GC subjects pain free at week 8).Incidence of adverse events was low (7 [14.9%]GC subjects; 5 (10.2%)FP-MD subjects), with headache being most commonly reported.Once-daily FP-MD supplementation significantly reduced joint pain, measured by both clinicians and subjects, compared with both GC and placebo, and was well tolerated.
Study Design: This observational study examined defined movement points of performance of a random sample of twentysix subjects working in an inner-city tertiary hospital. Based on the observed biomechanical movement points of performance expressed, Movement Dysfunction or Movement Proficiency for a simple bending task was determined. No subjects declined participation in the study. Background: Movement Dysfunction (MD) is hypothesised to be a significant contributor to the high prevalence of Non-Specific Low Back Pain (NSLBP) in our modern industrialized society. Treatment of low back pain symptoms is conventionally directed towards symptoms. This is clearly apparent by the misguided yet accepted diagnosis and often misused label of “Non-Specific Low Back Pain” which itself is not a diagnosis at all but an admission that the disease causing the symptom remains nebulous. This is unacceptable if progress is to be achieved in controlling the rising prevalence and economic burden of this condition. If the aforementioned hypothesis and authors are correct, in that the disease causing NSLBP symtoms is spino-pelvic Movement Dysfunction, a distinctive management paradigm shift can be implemented with the treatment targets being those of neurologically corrupted motor patterns which manifest as default poor bending technique during activities of daily living, be they trivial or physically demanding. Accelerated musculo-skeletal structural degeneration (degeneritis) and back pain symptoms are secondary sequelae. Tertiary sequale include multifidus muscle fatty atrophy, micro-instability, symtomatic neural compression, macroinstability and central sensitisation. The progression from episodic back pain to chronic back pain and structural changes that require surgical consideration are all preventable if low back pain is considered to be a primary neurological movement disorder and we shift our focus away from common, expensive, invasive and often poorly efficacious strategies such as interventional nociceptor blocks (interventional pain blocks), strengthening and stretching exercise therapy, manual therapy adjustments and deep tissue release in favour of primarily restoring the primary condition of corrupted central nervous system motor patterns that express movement dysfunction of the lumbo-pelvic spine. This is observable as default poor bending technique for simple activities of daily living. Accumulatively poor bending drives biomechanical stress that drives biological inflammation, pain, disability and progressive structural break down of the spinal integrity entrenching a feed back loop that is currently recognised as degeneration or spondylosis. This is should be more appropriately referred to as accelerated symptomatic degeneration or degeneritis signifying its pathological attributes which are distinct from normal age related and pain free degeneration. Objectives: Presently the critically important definition of MD in relation to low back pain and therefore its prevalence in the community has not been defined in peer reviewed scientific literature. This article defines and justifies the desired points of performance of healthy movement and highlights the high prevalence of movement dysfunction postulating that this is the root cause disease creating NSLBP symptoms. Methods: Twenty-six consecutive random and convenient subjects were asked to perform a movement task of placing a cap screw top on a drink bottle positioned at knee height. A kinematic pass or fail mark was assigned by proficiency in what we have termed the “NeuroHAB” screening tool. Results: Only two subjects (eight percent) out of twenty-six scored a pass whilst performing a simple bending movement task that would be expected to be representative of movement that occurs repetitively throughout ones normal activities of daily living in modern industrialised society. Conclusions: Utilising the NeuroHAB screening we are able to characterise MD in a work place highly representative of the normal daily physical activity demands of everyday Australians to be at a surprisingly high prevalence consistent with the high and increasing prevalence of low back pain and supportive of the hypothesis that low back pain is primarily a functional movement disorder currently being poorly treated by targeting secondary structural changes and symptoms of MD with strength and conditioning and the ever increasing myriad of pain symptom interventions that have little to no ability to reverse corrupted neurologically derived motor patterns. Simply stated, effective rehabilitation should be focused on reversing the disease of Movement Dysfunction of the lumbo-pelvic spine if we are to make meaningful progress with the treatment of low back pain symptoms [1-13].
Objective: To explore the current situation of end-of-life care self-efficacy of junior nurses in the operating room of a tertiary general hospital and the factors affecting it, and to provide a basis for improving the quality of end-of-life care services for junior nurses in the operating room. Methods:A cross-sectional survey of 185 clinical nurses in a tertiary general hospital in Guangdong Province was conducted using a convenience sampling method, a general information questionnaire, and the End-of-Life Care Self-Efficacy Scale (EOLPMSS). Results:The total score of end-of-life care self-efficacy of junior nurses in the operating room was (64.07±17.22),and regression analysis showed that gender, department, whether they had received training courses related to hospice education, whether they had bereavement experience, and their attitudes toward death were the influencing factors of end-of-life care self-efficacy (P<0.05). Conclusions:The end-of-life care self-efficacy of junior nurses in the operating room is at a low level.It is recommended that nursing managers develop a rotation plan for special wards during the standardized training of junior nurses, and develop an endof-life care competency enhancement course that meets the characteristics of the operating room, so as to improve the end-of-life care self-efficacy of nurses in the operating room.
Objective: To investigate the social support, work stress and retention intention of nurses in newly built hospital districts and to explore their correlation. Methods: Convenience sampling, general information questionnaire, social support rating scale, nurses’ work stressor scale, and nurses’ willingness to stay in the job questionnaire were used to investigate 134 nurses in newly built hospital districts. Results: The total score of willingness to stay (19.12±4.29), social support was significantly positively correlated with willingness to stay (R=0.354, P<0.01), and work stress was significantly negatively correlated with willingness to stay (R=-0.63, P<0.01). Conclusions: Nursing managers should take appropriate measures to improve social support for nurses, reduce nurses’ work pressure, and then enhance nurses’ willingness to stay in their jobs and stabilize the nursing team.
