Physical Therapy Following Saucerisation of Discoid Meniscus – a Case Study

Introduction: Discoid meniscus is a structure with altered shape, which causes it to frequently undergo injuries and lesions. Pain, limping, limited range of motion of the knee joint and swelling are characteristic signs of this pathology. Therapeutic possibilities include meniscectomy and saucerisation. Research objective: The study aim was assessment of the therapeutic effectiveness in a patient after saucerisation of discoid meniscus. Material and methods: A 12-year-old female patient after saucerisation of lower left limb lateral discoid meniscus (type I) was subjected to 32-week physical therapy treatment. Testing included determining the range of knee joint flexion and extension movements, as well as measuring the circumference of the lower extremities 15 cm above the patella. The Kujala Score (Anterior Knee Pain Scale) and Ikeuchi grading system were employed during the 1st, 3rd, 8th, 21st and 32nd weeks postoperatively. Results: In the final stage of physical therapy, complete range of knee joint motion was achieved, the Kujala Scale score totalled 98 points and the thigh circumference of the operated limb increased by 4 cm. The circumferences of the lower extremities differed by 2 cm in the final phase of physical therapy. Conclusions: The employed postoperative protocol effectively influenced the functional state of the patient.

Advanced Glycation End-products Are Associated With Limited Range of Motion of the Shoulder Joint Following Rotator Cuff Tears

Background: Most degenerative rotator cuff tears (RCTs) are associated with a limited range of motion (ROM) of the shoulder joint. Additionally, patients with diabetes mellitus (DM) show a higher frequency of limited ROM. Recently, advanced glycation end products (AGEs) of proteins have been observed to cause tissue fibrosis, primarily through abnormal collagen cross-linking and oxidative stress. In this study, we investigated the effect of AGEs on ROM limitation in the shoulder capsule and its relationship with DM.Methods: 16 patients (8 each in the DM and non-DM groups) who underwent arthroscopic surgery for RCT with limited shoulder ROM were included in this study. AGE-related pathologies in both groups were compared, and the relationship between AGE accumulation and shoulder joint ROM was evaluated. Shoulder capsule tissue was harvested and subjected to histological and in vitro evaluation. Results: The DM group displayed high levels of AGEs and reactive oxygen species (ROS), and reduced cell viability. There was a significant positive correlation between ROS expression, apoptosis, and preoperative hemoglobin A1c. ROS expression, apoptosis, and ROM of the shoulder joint showed a negative correlation. The NADPH oxidase (NOX) expression and collagen III/I ratio were significantly higher in the DM group than in the non-DM group.Conclusions: The DM group showed significant AGE deposition in the shoulder capsule. Additionally, there was a significant association between AGEs and ROM limitation. The oxidative stress induced by AGE deposition, which leads to fibrosis and local inflammation, might contribute to the limited ROM of the shoulder joint.

Peripheral edema: A common and persistent health problem for older Americans

Peripheral edema (i.e., lower limb swelling) can cause pain, weakness, and limited range of motion. However, few studies have examined its prevalence in the U.S. or its association with demographics, comorbidities, activity, or mobility. This study used data from the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults (age 51+/ N = 19,988 for 2016), to evaluate time trends and correlates of peripheral edema using weighted descriptive statistics and logistic regressions, respectively. Peripheral edema was assessed with the question “Have you had… // Persistent swelling in your feet or ankles?” The weighted prevalence of edema among older U.S. adults was 19% to 20% between 2000 and 2016. Peripheral edema was associated with older age, female sex, non-white race, low wealth, obesity, diabetes, hypertension, pain, low activity levels, and mobility limitations (odds ratios ranging from 1.2–5.6; p-values ≤0.001). This study provides the first estimates of national prevalence and correlates of peripheral edema among older Americans. Peripheral edema is common and strongly associated with comorbidities, pain, low activity levels, and mobility limitations, and disproportionately affects poorer and minority groups. Peripheral edema should be a focus of future research in order to develop novel and cost-effective interventions.

Adapt

<p>This paper presents a system for digitally manufacturing hyper personalised sets of cutlery for stroke patients. Stroke produces a wide variety of physical, cognitive, emotional and social effects that vary widely among individuals and may include weakness or paralysis on one side of the body, contractures and inability to rotate joints. This design addresses the factors including weakened grip strength, contracted wrist and fingers, limited range of motion in the wrist, hand tremors and lack of control. Becoming independent again is an essential stage for patients and difficulty performing standard eating tasks is a commonly reported effect after stroke, which is challenging physically and emotionally. There are existing ergonomic eating aids on the market, but none that offer personalisation for the widely different physiological effects of stroke, or that effectively integrate a sense of progression and achievement, which is the key to keeping patients motivated and confident throughout the rehabilitation process. This study investigates the way design can help reduce product related and social stigma for upper limb stroke rehabilitation patients in the use of cutlery. This research explores the way that a parametric system can be implemented to aid clinicians in identifying the individual needs of patients against a list of criteria. This design study has developed a set of cutlery that assists patients, making them feel confident and comfortable using cutlery in situations outside of their homes, as well as assisting as a therapy device. This research presents a parametric system that allows for controlling the variables relative to the design criteria based on the patient’s physiological abilities. The variables include the ability to change the diameter and size of the handle, the curve of the utensil in the (x,y) plane, the angle of the handle in the (x,z) plane and the depth of the finger groove which accommodates the index finger. The paper presents the main findings from how participants experienced stigma, clinicians feedback on the appropriateness of the cutlery designs, and how personalisation contributes to motivation within therapy. These main findings conclude that cutlery designed for stroke patients needs to be personalised, as each patient has very individual needs according to their very individual impairments. Current cutlery does not address them all and even less address them through personalisation. The specific variables in the system need to be controlled and restricted to ensure that all 40,000 of the possible outcomes are effective.</p>

Adapt

<p>This paper presents a system for digitally manufacturing hyper personalised sets of cutlery for stroke patients. Stroke produces a wide variety of physical, cognitive, emotional and social effects that vary widely among individuals and may include weakness or paralysis on one side of the body, contractures and inability to rotate joints. This design addresses the factors including weakened grip strength, contracted wrist and fingers, limited range of motion in the wrist, hand tremors and lack of control. Becoming independent again is an essential stage for patients and difficulty performing standard eating tasks is a commonly reported effect after stroke, which is challenging physically and emotionally. There are existing ergonomic eating aids on the market, but none that offer personalisation for the widely different physiological effects of stroke, or that effectively integrate a sense of progression and achievement, which is the key to keeping patients motivated and confident throughout the rehabilitation process. This study investigates the way design can help reduce product related and social stigma for upper limb stroke rehabilitation patients in the use of cutlery. This research explores the way that a parametric system can be implemented to aid clinicians in identifying the individual needs of patients against a list of criteria. This design study has developed a set of cutlery that assists patients, making them feel confident and comfortable using cutlery in situations outside of their homes, as well as assisting as a therapy device. This research presents a parametric system that allows for controlling the variables relative to the design criteria based on the patient’s physiological abilities. The variables include the ability to change the diameter and size of the handle, the curve of the utensil in the (x,y) plane, the angle of the handle in the (x,z) plane and the depth of the finger groove which accommodates the index finger. The paper presents the main findings from how participants experienced stigma, clinicians feedback on the appropriateness of the cutlery designs, and how personalisation contributes to motivation within therapy. These main findings conclude that cutlery designed for stroke patients needs to be personalised, as each patient has very individual needs according to their very individual impairments. Current cutlery does not address them all and even less address them through personalisation. The specific variables in the system need to be controlled and restricted to ensure that all 40,000 of the possible outcomes are effective.</p>

The effect of post-fixation olecranon lengthening on range of motion of the elbow: a cadaveric study

Background Principles of fixation of comminuted olecranon fractures include anatomical reduction of the articular surface and restoration of ulnohumeral joint motion. However, comminution sometimes may not permit anatomical fixation of fracture fragments, resulting in inadvertent olecranon lengthening after plate fixation. The aim of our study is to investigate the relationship between olecranon lengthening following plate fixation and loss of elbow extension. Materials and methods Transverse olecranon osteotomies were performed on 8 cadaveric elbows. The osteotomy sites were then fixed with olecranon plates. Lengthening of the osteotomy sites were simulated by placement of 2mm, 4mm, 6mm and 8mm blocks. Lateral view photographs of the elbows were taken after each degree of lengthening. These photographs were then printed and measurements of elbow extension were performed with a goniometer with average values taken. The measurements were tabulated and statistical analysis performed to determine the relationship between degree of elbow extension loss and amount of olecranon lengthening. Results Average values of each degree of lengthening (at 2mm, 4mm, 6mm and 8mm) were taken and compared with the baseline measurement (at 0mm). Cluster analysis showed that for every increment in osteotomy length of 2mm, there is a corresponding increase of 0.79° of elbow extension loss (p<0.01, 95% confidence level 0.55°-1.03°). Conclusion Lengthening of olecranon by increments of 2mm correlates positively with loss of elbow extension. This shows that inadvertent intra-operative olecranon lengthening post-fixation may result in limited range of motion. However, it is reassuring to know that the small degree of extension loss may not translate to functional limitation.

A Study Protocol on the Effectiveness of Post Mastectomy Exercises in Breast Cancer Patients on Reduction of Lymphedema and Improving Range of Motion among Patients Undergone Mastectomy

Background: Breast cancer is the most commonly diagnosed type of cancer in the world and it is a major stressor in women's lives. Breast cancer cases are increasing in both rural and urban settings. Mastectomy is a procedure that removes the breast to prevent cancer cells from returning. Many complications can develop after a mastectomy but lymphedema and limited range of motion are the most prevalent. The present study aimed to assess the effectiveness of post mastectomy exercises in breast cancer patients on reduction of lymphedema and improving range of motion among patients undergone mastectomy. Objectives: To assess pre interventional level of lymphedema among patients undergone mastectomy. To assess pre interventional range of motion among patients undergone mastectomy. To evaluate the effectiveness of post mastectomy exercises in reducing lymphedema among patients undergone mastectomy To evaluate the effectiveness of post mastectomy exercises in improving range of motion among patients undergone mastectomy. To associate demographic variable with post mastectomy exercises. To associate correlation of post mastectomy exercise with lymphedema and range of motion. Methodology: A pre interventional one group pretest posttest design would be adopted to assess the effectiveness of post mastectomy exercises in breast cancer patients on reduction of lymphedema and improving range of motion among patients undergone mastectomy. In this study interventional analytical study will be used. Purposive sampling technique will be used to collect the data. The study will include 30 patients undergone mastectomy will be assessed by using American lymphology lymphedema scale and Elvaru STJ (Subtalar joint) range of motion and range of motion reliability tool with the help of inch tape and goniometer and then post mastectomy exercises will be teach by researcher as intervention. Expected Results: The goal of this study is to see how effective post-mastectomy exercises are at reducing lymphedema and improving range of motion in breast cancer patients who had undergone mastectomy. Teaching post-mastectomy exercises can help the respondents reduce lymphedema and improve their range of motion.

Septic arthritis of multiple native joints following tooth extraction

<p>Infection of the distant parts of the body especially the joints after a tooth extraction is uncommon, but when it occurs due to the virulence of the organism or due to the risk factors, it may cause severe joint infection with abscess formation and may limit the movements. We report a case of arthritis of the knee joint along with involvement of other joints following mandibular third molar teeth extraction one week postoperatively. The patient had swelling and limited range of motion of the involved joints, pain over other multiple joints. The patient had two episodes of postoperative septic arthritis following each mandibular third molar extraction. He was diagnosed of having septic arthritis and treated with antibiotics, analgesics, and steroids, that resolved after 3 weeks. </p>

Treatment of Severe Ptosis by Conjoint Fascial Sheath Suspension

Objective. To explore the role of conjoint fascial sheath (CFS) suspension in the treatment of severe ptosis. Methods. A total of 110 patients with severe ptosis who were admitted to our hospital from May 2018 to December 2020 were included. Fifty-seven patients treated with frontalis suspension were assigned into group A, and the remaining 53 patients treated with CFS suspension were assigned into group B. The curative effect, ocular surface alterations, complications, and satisfaction in the two groups were compared. Results. Patients in group B suffered from severe upper eyelid retraction and lid lag than those in group A, as well as more limited range of motion (ROM) ( P < 0.05 ). The curative effect and patient satisfaction in group B were higher than those in group A ( P < 0.05 ). Postsurgical complications in group B were fewer than those in group A ( P < 0.05 ). Conclusion. CFS suspension is effective in the treatment of severe ptosis.

P080 Acroosteolysis: a rare complication or a co-occurrence with Juvenile Idiopathic Arthritis?

Background Acroosteolysis refers to a destructive process involving the distal phalanges of the fingers and toes that may extend to metacarpals or metatarsals. Rarely idiopathic, the diagnosis of primary acroosteolysis requires ruling out other causes. Juvenile idiopathic arthritis is an exceptional aetiology of acroosteolysis occurring mainly in psoriatic arthritis. Here by a case of juvenile idiopathic arthritis associated with acroosteolysis of the toes. Methods A 13-year-old girl with no past medical history, presented to our department of rheumatology with oligoarthritis affecting both wrists and knees. She had no familiar history of psoriasis nor rheumatic diseases. She described a dull ache and recurring swelling of knees evolving for &gt;6 years associated with a macular rash of the chest without fever. On examination, the knees were swollen with a limited range of motion of &lt; 90°. Examination of the spine and sacroiliac joints was unremarkable. There was no deformity, no dysmorphic syndrome nor ligamentous hyper laxity. The mucocutaneous examination was normal. Similarly, there was no hepatosplenomegaly or swollen lymph nodes. Laboratory investigations showed high acute phase reactants and normal blood count. Rheumatoid factor, anti-cyclic citrullinated peptide antibodies and antinuclear antibodies were also negative. Besides, she was negative for HLAB-27. Ophthalmic examination did not show any sequelae of uveitis. Results Plain radiograph of the feet revealed bone resorption of the second and fifth distal phalanges without signs of reconstruction. Other secondary causes of acroosteolysis were ruled out. The diagnosis of oligoarticular juvenile idiopathic arthritis was made. In view of the involvement of the distal phalanges, the phenotype of psoriatic arthritis was probable. The patient was initially treated with non-steroidal anti-inflammatory drugs as well as intraarticular injections of corticosteroids in knees. As the flares persisted, she was put on Methotrexate at a dosage of 15 mg per week with marked clinical improvement. Conclusion Our case illustrates a possible occurrence of acroosteolysis of the feet in the field of an active juvenile idiopathic arthritis. It is important to rule out other causes and make a rapid diagnosis in order to ensure appropriate management decisions.