Does MRI Knee in Those over 50 Years with Knee Pain in Osteoarthritis Alter Management? A Retrospective Review

2021 ◽  
Author(s):  
Alexandra N. Murphy ◽  
Bryan Yelverton ◽  
Kevin Clesham ◽  
Kathy Hassell ◽  
Eoin Kavanagh ◽  
...  
Keyword(s):  
Knee Pain ◽  
Retrospective Review ◽  
Clinical Information ◽  
Management Plan ◽  
Knee Oa ◽  
Appropriate Treatment ◽  
Management Plans ◽  
Magnetic Resonance Imaging Mri ◽  
Cause Of Pain

AbstractKnee osteoarthritis (OA) is a significant cause of pain and disability worldwide. Imaging provides diagnosis, prognostication, and follow-up. Radiographs are first line, useful, and inexpensive. Magnetic resonance imaging (MRI) can detect additional features not seen on radiograph, but it is of questionable usefulness in the management of knee OA. Our aim was to investigate the usefulness of MRI in the workup of knee OA and whether MRI alters management in knee OA. A retrospective review was performed of consecutive MRI knees performed for knee pain in those over 50 years. Clinical information and documentation of management plan pre- and post-MRI were collected. Assessment was made whether the MRI results influenced the final management plan. Of the 222 MRI knees included for study, the majority (62.2%) had not had a recent radiograph. OA was reported in 86.9% of radiographs and 89.6% of MRI. On MRI, the most prevalent finding was tearing/abnormality of the medial meniscus, seen in 47% of MRIs overall, increasing to all in severe OA. MRI assisted with management in 9.5% of all (21/222) patients, and changed management plans in 23% of those that had documented management plans prior to the MRI (6/26 patients). MRIs can guide tailored management in knee OA and are useful for surgical planning; however, they should only be ordered in certain cases, and a radiograph should always be performed first. MRI should be considered if symptoms are not explained by OA alone or the appropriate treatment option requires MRI.

Exercise and Osteoarthritis: Are We Stopping Too Early? Findings from the Clearwater Exercise Study

2006 ◽  
Vol 14 (2) ◽  
pp. 169-180 ◽  
Author(s):  
Frances V. Wilder ◽  
John P. Barrett ◽  
Edward J. Farina
Keyword(s):  
Clinical Trials ◽  
Knee Pain ◽  
Exercise Intervention ◽  
Pain Reduction ◽  
Optimal Length ◽  
Knee Oa ◽  
Pain Scores ◽  
Time Periods

The value of exercise for people with knee osteoarthritis (OA) receives continuing consideration. The optimal length of study follow-up time remains unclear. A group of individuals with knee OA participating in an exercise intervention was followed for 2 years. The authors quantified the change in knee-pain scores during Months 1–12 and during Months 13–24. Eleven individuals with radiographic knee OA and knee-pain scores of 2+ were evaluated. Pain scores were collected weekly from participants who exercised three times a week. Participants demonstrated pain reduction during both time periods. Pain reduction during Months 13–24, –10.7%, was slightly higher than pain reduction during Months 1–12, –7.8%. Among people with knee OA who exercise, these findings suggest that knee-pain amelioration continues beyond 12 months. Clinicians should consider encouraging long-term exercise programs for knee-OA patients. To best characterize the effect of exercise on knee pain, researchers designing clinical trials might want to lengthen the studies’ duration.

scholarly journals The Effect of a Lower Body Positive Pressure Supported Treadmill Exercise Regime on Systemic Biomarkers of Inflammation and Cartilage Degradation in Individuals with Knee Osteoarthritis: A Pilot Study

2021 ◽  
Vol 9 (3) ◽  
pp. 18
Author(s):  
Stephen Cornish ◽  
Jason Peeler
Keyword(s):  
Articular Cartilage ◽  
Knee Pain ◽  
Weight Bearing ◽  
Cartilage Degradation ◽  
Treadmill Walking ◽  
Positive Pressure ◽  
Control Group ◽  
Knee Oa ◽  
And Cartilage

Background: Knee osteoarthritis (OA) has been linked to a chronic low-grade inflammatory response and altered metabolic activity of articular cartilage. Objective: The purpose of this investigation was to evaluate the effectiveness of a 12-week (3 times/week) lower body positive pressure (LBPP) treadmill walking regime on knee pain and systemic biomarkers of inflammation and cartilage degradation. Methods: Sixteen overweight (BMI > 25 kg/m2) knee OA patients were randomized to a LBPP treadmill walking exercise group (N = 7) or non-exercise control group (N = 9). Baseline and 12-week follow-up assessments evaluated the following dependent variables: acute knee pain during full weight bearing treadmill walking; inflammatory biomarkers (C-reactive protein, interleukin-1β, interleukin-6, s100A8/A9, and tumor necrosis factor-α), and catabolic metabolism of articular cartilage (sCOMP). Results: Knee pain at baseline and follow-up remained unchanged for the non-exercise control group (P > 0.05). However, knee pain for the LBPP exercise group was significantly decreased at follow-up (P ≤ 0.05). No differences in the biomarkers of inflammation and cartilage degradation were observed for between and within group comparisons (all P > 0.05). Conclusions: Data suggested that the LBPP supported walking regime could be effectively used to promote regular weight bearing exercise without exacerbation of knee joint pain and did not increase levels of systemic inflammation or catabolic activity of articular cartilage in overweight knee OA patients. This pilot investigation offers important insight regarding the potential role that the LBPP technology could play in facilitating investigations examining the disease modifying effect of exercise on knee OA pathogenesis.

455 PROSPECTIVE EVALUATION OF FRAILTY IN INDIVIDUALS WITH KNEE PAIN IN MALAYSIAN ELDERS LONGITUDINAL RESEARCH (MELOR) STUDY

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
C L Chiew ◽  
S Mat ◽  
K S Hui ◽  
M P Tan
Keyword(s):  
Knee Pain ◽  
Longitudinal Research ◽  
Computer Assisted ◽  
Kuala Lumpur ◽  
Frailty Status ◽  
Knee Oa ◽  
Home Based ◽  
Increased Risk ◽  
The Relationship

Abstract Introduction Osteoarthritis (OA) is a major cause of physical impairment in older persons. Few studies have determined the relationship between the presence of OA and frailty. We evaluated the prospective relationship between knee pain and frailty in a Malaysian longitudinal cohort. Method Data from Malaysian Elders Longitudinal Research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted questionnaires and hospital-based health-checks from 2013–2015. The presence of knee pain was determined with the single question, ‘do you have pain in your knee(s)?’. Frailty status was determined at follow-up in 2019 using SARC-F. Results Data from 1,226 individuals, mean age (SD) = 68.97 (7.48), range = 54–97 years and 56.6% women at baseline, were included. 408 (33.3%) had knee pain. Individuals with knee pain were significantly more likely to be female (66.2% vs 51.8%, p < 0.001). Ethnic differences existed in the presence of knee pain (Malay 43.4% vs Chinese 24.8% vs Indian 31.9%, p < 0.001). Individuals with knee pain was more likely to have diabetes (40.1% vs 29.9%, p < 0.001), hypertension (38.3% vs 27.0%, p < 0.001), dyslipidaemia (38.4% vs 26.5%, p < 0.001) and obesity (52.6% vs 30.2%, p < 0.001). After adjustment for confounders, individuals with knee pain were more significantly to develop frailty at follow-up [odds ratio (95% confidence interval) =2.71(1.61–4.58)]. Conclusion Knee pain was associated with an increased risk of frailty with 5-years follow-up in an urban population in Kuala Lumpur. More detailed evaluation using imaging and clinical diagnosis of osteoarthritis is now indicated. Future studies should also seek to identify modifiable risk factors for the development of frailty in individuals with knee OA and develop strategies to prevent frailty.

scholarly journals Posterior Knee Pain: An Unusual Cause

2015 ◽  
Vol 5 (1) ◽  
pp. 58-60
Author(s):  
Alamgir Samdany ◽  
Guljar Ahmed ◽  
Abdul Gani Ahsan
Keyword(s):  
Knee Pain ◽  
Lower Limb ◽  
Venous Malformation ◽  
Popliteal Fossa ◽  
Diagnostic Tools ◽  
Disease Entities ◽  
Arterio Venous Malformation ◽  
Posterior Knee ◽  
Cause Of Pain

The pain around the posterior knee called ‘popliteal fossa’ has been known to be caused by a variety of disease entities. Whatever the causes, the challenge remains in diagnosis. Proper history and clinical examination followed by uses of appropriate diagnostic tools are secrets to success. Venous malformation is a very rare cause of pain in popliteal area and its diagnosis is frequently delayed, missed or given incorrectly. Here, we report a case of a 24-year-old patient who presented with posterior knee pain for 2 years and was diagnosed as a case of intramuscular arterio-venous malformation by lower limb angiography. This patient was treated successfully by surgical resection. His follow-up was satisfactory with no evidence of recurrence. DOI: http://dx.doi.org/10.3329/jemc.v5i1.21499 J Enam Med Col 2015; 5(1): 58-60

Conservation management plans

2019 ◽  
Vol 38 (4) ◽  
pp. 573-588
Author(s):  
Derek Worthing ◽  
Samantha Organ
Keyword(s):  
Conservation Management ◽  
Management Plan ◽  
Management Tools ◽  
Frontline Staff ◽  
Content Type ◽  
Social Good ◽  
National Heritage ◽  
Management Plans ◽  
Key Issues

Purpose The purpose of this paper is to identify factors that contribute to the development of an effective conservation management plan (CMP). Design/methodology/approach The approach was based on a literature review from which key issues and concerns were identified. This was followed by in-depth interviews with a number of creators and users of CMPs. Findings CMPs have developed as an identifiable process with the key stages having a logic and synergy with each other. The research found that undue emphasis was placed on some stages at the expense of others which lead to ineffective management tools often being produced. The reasons for this are related to the interests and background of the creators and a lack of interaction with organisational culture and processes – and importantly a failure to engage with frontline staff. In addition, there were also resource and skill constraints within the client organisation. Research limitations/implications Interviews were conducted with six creators (consultants) and seven users. These were mostly from national heritage organisations and specialist heritage consultants. A wider range of user organisations and consultants could be identified for follow-up research. Also those who actually deliver CMPs “on the ground” and day to day could form an important part of the development of this research. Practical implications CMPs should be practical working management tools which have to be used by the heritage organisation in order to be effective. This research will hopefully help practitioners focus on what needs to be done in order to produce an effective plan. Social implications The conservation of built heritage is essentially concerned with the protection of a social good. CMPs have the potential to provide effective protection of that which is seen as valuable and significant to individuals, groups and society at large. Originality/value The management of heritage is an area that is generally under-researched. This work will hopefully be engaged with by academics and practitioners in order to help establish and promote a wider interest in the field.

scholarly journals POS1094 SYNOVITIS IS FACTOR OF OSTEOARTHRITIS KNEE PROGRESSION IN PATIENTS WITH LESS THAN 5 YEARS OF DISEASE DURATION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 827.1-827
Author(s):  
L. Alekseeva ◽  
N. Kashevarova ◽  
E. Taskina ◽  
D. Kusevich
Keyword(s):  
Knee Pain ◽  
Clinical Examination ◽  
Disease Duration ◽  
Radiographic Progression ◽  
Musculoskeletal Ultrasound ◽  
Knee Joints ◽  
X Ray ◽  
Knee Oa ◽  
Radiological Stage

Background:There are many studies about investigation of risk factors (RF) of knee osteoarthritis (OA) radiologic progression. Especially, in patients with small disease duration. At the moment, there are ambivalent of results of previous studies, lead to uncertain role of synovitis.Objectives:The aim of study is to investigate relationship between knee OA synovitis and progression risk in patients with small disease duration during a follow-up period of 5 years.Methods:Eligible patients had knee OA based on ACR criteria with x-ray confirmation; baseline (BL) disease duration less than 5 years. Patients were evaluated at BL and at 5-year follow-up, using the questionnaires, clinical examination, knee joints pain by visual analog scale (VAS), musculoskeletal ultrasound and X-ray. Unadjusted p-values are presented.Results:Among 52 adults with knee OA (mean age ± standard deviation, 59.11 ± 8.95 years; 100% female) had the proportion of patients at BL 42.3% (n=22), 46.2 % (n=24), 11.5% (n=6) by disease stage 1,2 and 3, respectively. Patients were categorized into 2 groups by progression during 5 years from BL based on changes of radiological stage. After 5-years follow-up period the progression of knee OA was established in 14 patients (1 group) and in 38 patients (2 group) the progression by radiological stage was absent. BL patients’ characteristics were similar across 1st and 2nd groups: mean age 58.29±7.68 vs 56.05±8.74, р>0.05; disease duration 3.43±1.34 vs 3.47±1.33, р>0.05. Individuals with knee OA progression had worse knee joints pain during walking (60.36±18.33 vs 48.71±17.81, р=0.043), higher body mass index (BMI) (34.45±4.60 vs 28.92±4.92 kg/m2, р=0.001), higher frequency of knee synovitis by clinical examination (42.9% vs 10.5%, RR=4.07; 95%Cl (1,3-12,3), р=0.01) and by musculoskeletal ultrasound (57.1% vs 18.4%, RR=3.1; 95%CI (1.38-6.96), р=0.009). At 5-years follow-up knee pain was significantly greater for 1st group (69.64±18,49 vs 55.76±12.76, р = 0.003), higher BMI (35.74±5.83 vs 30.64±4.64, р = 0.002), also higher frequency of knee synovitis by clinical examination (57.1% vs 10.5%, RR = 5.4 (95%Cl 1.9-15.2), р=0.001) and by musculoskeletal ultrasound (50% vs 13.2%, RR=3.8 (95%Cl 1.4-10.0), р=0.009). Spearman correlation coefficients between radiologic stage and OA progression factors were indicated: between radiologic stage and knee pain during walking (r = 0.34, p<0.05), BMI (r = 0.46, p<0.01), knee synovitis by musculoskeletal ultrasound (r = 0.41, p<0.01). Multivariate (discriminant) analysis was determined that synovitis is a significant predictor of radiographic progression (p < 0.05).Conclusion:The proportion of patients with knee synovitis by clinical examination and musculoskeletal ultrasound data increased by 5-year follow-up from BL. Synovitis is a significant predictor of radiographic progression of knee OA in patients with small disease duration.Disclosure of Interests:None declared.Figure 1.

scholarly journals Appearance of cerebellar cyst following microvascular decompression to treat hemifacial spasm: a report of two cases and literature review

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052093211
Author(s):  
Yu Cui ◽  
Zhong-Xi Yang ◽  
Chun-Mei Wang ◽  
Zhan-Peng Zhu
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Rare Complication ◽  
Intracerebral Haematoma ◽  
Appropriate Treatment ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Safe Approach

Microvascular decompression (MVD) is an effective and safe approach for treating hemifacial spasm (HFS). Postoperative complications may include facial nerve palsy, hearing loss, intracerebral haematoma, and brainstem infarction. The occurrence of intracranial cyst following MVD is extremely rare, with few cases documented in the literature. Herein, the cases of two patients with HFS who developed ipsilateral cerebellar cyst following MVD are reported. The first patient was a 50-year-old male presenting with a 6-year history of HFS on the right side of his face. MVD was performed, and 12 days postoperatively he developed dizziness and nausea. Magnetic resonance imaging (MRI) showed a cyst in the ipsilateral cerebellum. Antibiotic treatment provided no benefit, and the cyst was drained. The second patient was a 44-year-old female presenting with a 4-year history of HFS on the right side of her face. MVD was performed, and 18 days following surgery, she developed dizziness and nausea. MRI showed an ipsilateral cerebellar cyst. Conservative treatment was applied and the cyst shrunk. At the 2-month follow-up appointment, symptoms were completely resolved in both patients. Cerebellar cyst is a rare complication following MVD. Timely diagnosis and appropriate treatment should be emphasized, and surgical treatment may be unnecessary.

scholarly journals Hyaluronic Acid Injections or Oral Nonsteroidal Anti-inflammatory Drugs for Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Trials

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989790 ◽  
Author(s):  
Larry E. Miller ◽  
Michael Fredericson ◽  
Roy D. Altman
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Randomized Trials ◽  
Knee Function ◽  
Knee Oa ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: Intra-articular hyaluronic acid (HA) injections and oral nonsteroidal anti-inflammatory drugs (NSAIDs) are common treatments for symptomatic knee osteoarthritis (OA). However, the comparative effects of these treatments are unclear. Purpose: To compare the efficacy and safety of intra-articular HA injections compared with oral NSAIDs for the treatment of knee OA. Study Design: Systematic review; Level of evidence, 1. Methods: We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for randomized trials of knee OA treatment with HA injections compared with oral NSAIDs. The main outcomes were knee pain, knee function, adverse events (AEs), serious AEs, study withdrawals, and study withdrawals because of AEs. Pooled effect sizes were reported at the final follow-up with standardized mean difference (SMD) for efficacy outcomes and risk ratio (RR) for safety outcomes. Results: In 6 randomized trials of 831 patients (414 HA, 417 NSAIDs), with follow-up ranging from 5 to 26 weeks, HA injections were associated with small, statistically significant improvements in knee pain (SMD, 0.15; P = .04) and knee function (SMD, 0.23; P = .01) compared with oral NSAIDs. The risk of AEs was lower with HA compared with NSAIDs (19.8% vs 29.0%; RR, 0.74; P = .01). The risk of a serious AE (RR, 1.37; P = .71), study withdrawal (RR, 1.05; P = .68), or study withdrawal because of an AE (RR, 0.65; P = .22) was comparable between groups. Gastrointestinal concerns were the most frequent AE reported, occurring more often with NSAIDs (23.4% vs 14.1%; P = .001). AEs reported more frequently with HA injections were injection site pain (11.7% vs 4.7%; P < .001), headache (8.4% vs 4.4%; P = .03), and arthralgia (8.1% vs 2.9%; P = .001). Significant heterogeneity or publication bias was not observed for any outcome. Conclusion: Comparing short-term outcomes of HA injections with oral NSAIDs for treatment of knee OA, HA injections provided statistically significant but not clinically important improvements in knee pain and function, along with a lower overall risk of AEs.

scholarly journals Factors associated with pain and osteoarthritis at the hip and knee in Great Britain’s Olympians: a cross-sectional study

2018 ◽  
Vol 52 (17) ◽  
pp. 1101-1108 ◽  
Author(s):  
Dale J Cooper ◽  
Brigitte E Scammell ◽  
Mark E Batt ◽  
Debbie Palmer
Keyword(s):  
Knee Pain ◽  
Weight Bearing ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Knee Oa ◽  
Modifiable Factors ◽  
Prevalence Of Pain

BackgroundKnowledge of the epidemiology and potentially modifiable factors associated with musculoskeletal disease is an important first step in injury prevention among elite athletes.AimThis study investigated the prevalence and factors associated with pain and osteoarthritis (OA) at the hip and knee in Great Britain’s (GB) Olympians aged 40 and older.MethodsThis is a cross-sectional study. A survey was distributed to 2742 GB Olympians living in 30 countries. Of the 714 (26.0%) who responded, 605 were eligible for analysis (ie, aged 40 and older).ResultsThe prevalence of hip and knee pain was 22.4% and 26.1%, and of hip and knee OA was 11.1% and 14.2%, respectively. Using a multivariable model, injury was associated with OA at the hip (adjusted OR (aOR) 10.85; 95% CI 3.80 to 30.96) and knee (aOR 4.92; 95% CI 2.58 to 9.38), and pain at the hip (aOR 5.55; 95% CI 1.83 to 16.86) and knee (aOR 2.65; 95% CI 1.57 to 4.46). Widespread pain was associated with pain at the hip (aOR 7.63; 95% CI 1.84 to 31.72) and knee (aOR 4.77; 95% CI 1.58 to 14.41). Older age, obesity, knee malalignment, comorbidities, hypermobility and weight-bearing exercise were associated with hip and knee OA and/or pain.ConclusionsThis study detected an association between several factors and hip and knee pain/OA in retired GB Olympic athletes. These associations require further substantiation in retired athletes from other National Olympic Committees, and through comparison with the general population. Longitudinal follow-up is needed to investigate the factors associated with the onset and progression of OA/pain, and to determine if modulation of such factors can reduce the prevalence of pain and OA in this population.

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

2020 ◽  
Author(s):  
Adam Lee ◽  
Adam Bajinting ◽  
Abby Lunneen ◽  
Colleen M. Fitzpatrick ◽  
Gustavo A. Villalona
Keyword(s):  
Literature Review ◽  
Retrospective Review ◽  
Review Of The Literature ◽  
Rare Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Nonaccidental Trauma ◽  
Comprehensive Literature Review ◽  
Healthy Infants ◽  
History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

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