News Category: General

In this study, orthopedic surgeons at the University of Southern California (USC) report 52 cases of upper extremity (UE) septic arthritis in adults seen in their clinic over a 10-year period.

Septic arthritis is caused by a bacterial infection. It affects the lower extremities most often. More rarely, the shoulder, elbow, or wrist may be the primary site of infection.

In reviewing all cases, the authors report that men were affected five times more often than women. Staph infection was the most common cause. Treatment was with surgical drainage and irrigation (cleansing) of the joint. Antibiotics were given for three to four weeks.

Studies show that early treatment is best for a good outcome. Chronic pain and persistent loss of motion can occur with a delay in diagnosis. Lab values can be helpful. Joint fluid can be examined for signs of bacteria and infection.

All ages can be affected by septic arthritis. Anyone with shoulder, elbow, or wrist pain should be considered for the possibility of joint infection. Doctors should expect to see more cases of septic arthritis as the American population ages. Patients with other health problems are at greater risk but young and healthy adults can be affected, too.

Around the world fibromyalgia syndrome (FMS) is a common problem among women. In this new study, patients at a worker’s compensation clinic are examined for incidence, cause, and risk factors for this condition.

Over 800 workers were included. About 3.6 per cent of the women had FMS, which they linked to a previous trauma or work-related injury. Psychologic problems were present in 70 per cent of the FMS patients. Depression and anxiety were the most common.

Most people with FMS have a wide variety of symptoms. Besides the main problem of joint and muscle pain, headaches, sleep disturbances, fatigue, and temperature intolerances are often reported. Changes in sleep patterns are a key feature of FMS.

It’s not clear if the mental and physical symptoms cause the FMS or occur as a result of this disorder. Scientists agree that most likely there is a connection between altered central nervous system function and FMS. No one is sure yet just what that link may be. The fact that women are affected most often points to a neurohormonal cause.

The results of this particular study suggest that FMS is more likely to occur among women of low socioeconomic status. Decreased work capacity and long-term disability are reported in more than half the cases. Neck injury seems to be a common injury that brings on FMS.

Fibromyalgia syndrome (FMS) is a condition of muscular pain and fatigue of unknown cause. It affects women more than men and can occur in childhood. It appears that many systems are involved such as the nervous system, the hormonal system, and the enteric (gut) system.

Exercise has clearly been shown to benefit patients with FMS. In this article, two physical therapists offer guidelines and advice on the advantages of exercise. Types of exercise and how to exercise are also included. Here are a few tips:

The last 10 years has brought some changes in the sports world. Sprinting has become a new event in ski-skating. Ski-skating is the freestyle cross-country skiing event. In this study, researchers at the Human Movement Science Programme in Norway look at the effect of body position on performance for this event.

Three different body positions (high, moderate, and deep) were compared. High is an upright position. Deep is more of a crouch position, and moderate is somewhere in between. The theory is that at high speeds, a crouch position would decrease air resistance. The result could be to decrease the skier’s time for the event.

One possible disadvantage of the deeper position is the need for greater muscle control and the effort required to stay in that position. Blood flow may be slowed down because of the flexed position of the legs. Fatigue may be a factor. And the skier can’t use his or her arms in this position.

Does the increased power from a deep position make up for the fatigue and loss of arm power?

Human movement engineers were able to study this question using a slide board with force plates in a wind tunnel. Male and female cross-country skiers were included in the study. Skiers participated in both a 30-second and a three-minute test.

Videos were used to record push-off and gliding movements. Power loss and friction forces were calculated. Oxygen use, heart rate, and lactate levels in the blood were measured for each skier. Lactate (also known as lactic acid) builds up in the blood when muscles are used without oxygen. A higher lactate level is more likely when the skier is crouched down because blood supply to the legs is less in this position.

The results showed a 30 per cent decrease in air resistance from the high to low position. This change means there’s a power loss in the low position. Power loss was greater in the three-minute test. This was probably caused by fatigue during the longer test.

Heart rate was the same in all three positions. Skiers used more oxygen in the high position. As expected, greater lactate levels were measured in the deep position.

The authors conclude that the deep crouch position may improve performance during sprinting.

Training will be needed to maintain this position for longer distances but the benefits may make it worthwhile. Even without the force generated by using the arms, a deep body position over longer distanced in ski-skating may give the skier a greater overall advantage.

This year the National Fibromyalgia Research Association (NFRA) is sponsoring a conference to present the latest research findings on fibromyalgia. Since more than six million Americans are affected by this disorder, the topic is of interest to many patients and health care professionals.

Patients with fibromyalgia have widespread muscular pain and tender points along with severe fatigue. Over 50 other symptoms of all sorts have also been reported along with the primary muscular pain. Females (including children) are the most likely group to develop fibromyalgia. Women ages 20 to 55 are affected most often.

The symposium will be held September 9-10, 2006 in Salem, Oregon. Several major areas of research will be presented and discussed at the meeting such as:

In this review article, Dr. Peter A. Simkin, a professor of medicine in rheumatology at the University of Washington (Seattle) presents six goals in gout management. Specific ways to reach these goals are also discussed. The goals include:

Exercise physiologists and nutritionists teamed up in this study to review a system often used to measure the intensity of physical activity. The system is called the Metabolic Equivalent of the Task or MET.

MET is calculated based on energy expended and resting metabolic rate (RMR) for each activity. The RMR is the rate at which the average person burns calories when at rest. For each individual, one MET is equal to that person’s RMR. Brushing the teeth and eating are in the one to two MET range. Moderate exercise such as walking a mile in 30 minutes is usually in the three to six MET range.

The MET system was based on the RMR of young, thin men with a TBF content of about 10 per cent. For people with greater TBF content, the standard MET system may not be an accurate measure of TEE.

In this study, researchers explore what happens when the MET system is used with heavy or obese subjects. Previous studies have shown that the MET system underestimates energy use in people who are overweight.

Two groups of women who gained weight over a one-year period of time were studied. One group lost weight and then gained it back. The second group gained weight during a pregnancy. The type of weight gain was different between the two groups. Group one increased in fat content while the pregnant group increased in mass more than fat.

It was expected that results would be different for these two groups. In fact, the results of this study showed that as a person’s total body fat (TBF) increased, the calculated total energy expended (TEE) became more and more inaccurate. Other studies support these findings and show the results are the equally inaccurate for men and for women.

The authors conclude that a modified MET system for overweight or obese individuals is needed. The effect of body fat content on RMR must be considered when calculating the TEE. As body fat content goes up, the estimated energy used is underestimated. Future studies are needed to compare TEE of people with different amounts of body fat engaging in various levels of activity.

Osteoporosis or brittle bones has been considered a woman’s disease for a long time. But new data shows it is a major problem for many men. In fact 30 percent of all hip fractures occur in men as a result of osteoporosis. In this report, Dr. Wright from the University of Pittsburgh reviews current facts about osteoporosis in men.

Fact:

In this article, doctors from the Northwestern University School of Medicine in Chicago review recent advances in drug therapy for rheumatoid arthritis (RA). New biologic agents designed to affect the immune system at the cellular level are being developed. Tocilizumab, Abatacept, and Rituximab are discussed in detail.

Tocilizumab is a monoclonal antibody. In trials with RA patients, 78 percent got at least 20 percent better. Side effects included increased cholesterol levels and abnormal liver function. Only short-term results (three months) are available so far. Tocilizumab works by itself but also works better when combined with methotrexate (MTX). MTX is a commonly used drug for RA.

Abatacept acts like an antibody. It attaches itself to a protein on the surface of T-lymphocytes (T-cells) and prevents the start up of T-cells. The effect is to stop the RA disease process. It is used for patients who have not had good results with disease modifying antirheumatic drugs (DMARD) therapy. Serious infections is a side effect of abatacept.

Rituximab is an anticancer drug that has been approved for use in RA patients who have not been helped by other drug therapies. It works by stopping B cells in the immune system. In a study of patients already taking MTX, the positive effects of rituximab lasted 48 weeks. The drug was given by IV. The only problem was a reaction in about one-third of the patients during the first infusion.

As research continues, progress will be made in treating patients with RA. It’s likely that today’s drugs will be used in combination with future biologic agents. The goal is to get the positive benefit of the drug without the negative side effects. For right now, it looks as though MTX and TNF-alpha antagonists will remain the standard treatment for RA.

If you have the start of degenerative arthritis will exercise make it better or worse? Many people believe that exercise wears away the joint cartilage even more.

Adults in the United States are already very sedentary. Over half don’t meet the minimum standard for physical activity. A diagnosis of osteoarthritis (OA) often pushes them toward greater inactivity.

But the truth is that moderate exercise early on is one of the best ways to reduce hip or knee pain from OA. In fact studies show that activity has the same effect on cartilage as it does on muscle and bone. It enhances and improves cartilage rather than wear and tear it down.

More study is needed to identify the exact “best” exercise program. Is “moderate” exercise the same for each person? Does the extent of joint damage make a difference? These and many other questions must be answered before specific exercise programs can be prescribed.

For now, adults with an early diagnosis of OA are advised to stay active and exercise regularly.

Patients who have arthroscopic surgery on any joint are at increased risk for infection. Those who have joint replacements could be in danger of implant failure from infection. The use of antibiotics to prevent infection is called prophylaxis. Prophylactic use of antibiotics is a form of “defensive medicine.”

The over use of antibiotics has led to bacteria that are resistant to antibiotics. Should everyone get antibiotics to keep this from happening?

In this report, Dr. P. R. Kurzweil from the Southern California Center for Sports Medicine offers his opinions about the use of antibiotics for arthroscopic surgery. His arguments are all in favor of prophylactic antibiotics. He gives the following reasons:

Doctors in Australia present a case report of a 37-year old woman with osteoporosis. Osteoporosis is a decreased bone mineral density. It can lead to thinning of the bones and fracture. This patient was 32 weeks into her second pregnancy. Pain started in both hips, then knees, then ankles. There was no history of trauma, accident, or illness.

After six weeks using crutches and anti-inflammatory drugs, the pain was so bad that she ended up in a wheelchair and had a cesarean section to deliver the baby. Her symptoms got better after the baby was born but it was a full year before she was back to normal.

There’s no way to tell what caused this rare case of osteoporosis. The most obvious risk factor was pregnancy. But bone loss is usually linked with decreased estrogen after menopause not increased during pregnancy.

Diagnosis and treatment of osteoporosis in pregnant women can be difficult. Lab work doesn’t show much and X-rays aren’t advised. MRI is possible but the woman in this study had claustrophobia. Bone scans after pregnancy confirmed the diagnosis.

When osteoporosis goes away as it did in this case, it’s called transient osteoporosis. Women in the last three months of pregnancy and middle-aged men appear to be affected most often by this condition. The hips are painful first but other joints can be affected.

More study is needed to find ways to treat transient osteoporosis. This is especially true during pregnancy when there’s a risk of fracture and the risks associated with cesarean section.

In this review article, a researcher from Harvard Medical School presents a summary of recent studies done on the effect of bisphosphonates on joint replacements. Both animal and human studies are reviewed.

Bisphosphonates are a group of manmade (synthetic) chemicals used to prevent bone loss in adults with osteoporosis. Doctors hope these drugs will also help joint implants last longer as well. The number one cause of implant failure is bone loss around the implant and implant
loosening.

With a total hip or knee replacement, there’s a change in the way load or force from body weight is transferred though the bone. Bone loss and implant instability can be the result. Scientists are testing out the idea that bisphosphonates could prevent bone loss before it starts or reverse bone loss after it has started.

Several studies have shown that bisphosphonates can improve and maintain bone quality in patients with total joint replacements. The exact dosage needed for these effects is unknown. More studies are need in this area.

Other studies are looking at improving bone ingrowth around implants. One group tried soaking bone grafts in a bisphosphonate solution before using them. Use of bisphosphonates with younger patients is also a topic of consideration and debate. New and improved bisphosphonates have opened up even more areas of research.

A small study of women with fibromyalgia using mechanical massage was done at Ohio State University. Full body massage was carried out on 10 patients once a week for 15 weeks. A special medical device called Cellu M6 was used to draw a skinfold between two motorized rollers. The fold was rolled and unrolled. Treatment was applied to the entire body.

Improvement was measured using pain, physical function, and the number of tender points before and after treatment. A diagnosis of fibromyalgia is often based on the presence of tender points in 18 areas of the body. The presence of 11 out of the 18 tender points is a positive diagnosis.

Almost all of the patients thought the treatment was very helpful. They wanted to continue the mechanical massage. Some were able to reduce their use of drugs for pain. Pain and tender points decreased by 50 percent.

The authors conclude the results of using this type of mechanical massage was positive enough to take it the next step. They plan to repeat the study on a larger number of patients next.

Many team sports require bursts of power in the arms and legs. More and more female athletes are involved in these sports such as basketball, volleyball, and hockey. In this study researchers in Australia measure the muscle power used by men and women while sprint cycling and arm cranking. They found body mass was the best way to predict muscle power.

We know that most men have more muscle power and strength than most women. But what if these measures were made in relation to body size? Would women be as powerful as men when strength is matched to body mass? Ten men and 10 women were compared to find out. Each subject was given a test on a machine for the legs and for the arms. A special X-ray called dual-energy X-ray absorptiometry or DXA was used to measure active muscle mass.

The authors report men appear to have more powerful muscles for sprint cycling. When the results are scaled to body mass, then men and women have equal power in the legs. Upper body power is a different story. Even when scaled to body mass, men still had more powerful arms when arm cranking.

The authors try to explain why this might be so. Perhaps there are differences in muscle fiber type. Or maybe there are hormonal or enzymatic differences. Data from other studies have shown that women have fewer muscle fibers in the arms compared to men.

The bottom line is that men have more powerful upper bodies compared to women when relative body size is taken into account. The exact reasons for this difference remain unknown.

Activity and exercise is important to the health of all adults. This has been shown in many studies so far. Yet older adults in independent living (IL) communities are often inactive. How can we change this? In this study researchers look at ways to get older adults to join physical activity programs.

A flyer was sent in the mail inviting 212 IL adults to attend a short class on exercise. Only 48 came. Only 38 wanted to join an exercise group. These 38 were divided into two groups. One group got just the flyer with information about the upcoming activity session. This was the information-only group.

The second group met with someone from the research team for 30 minutes. They took a survey about current level of physical activity. The results ranked their risk level for disability from low to high. The benefits of exercise and activity were reviewed with each member of this second cognitive-behavioral group. Everyone in both groups was given a chance to join an activity group.

The authors found the information-only group was much less likely to attend a physical activity session. They conclude a brief cognitive-behavioral session does build interest in physical activity for older adults in an IL community. Education about the risks of physical inactivity on future health and function seems to make a difference in IL residents.

The first two years a patient has rheumatoid arthritis are crucial. Without treatment early on, permanent joint damage can occur. In this report Dr. Kevin Moder reviews present day lab tests and imaging studies. He makes some predictions about the future use of such testing.

X-rays are used to start a baseline of how the joint looks but they don’t show swelling of the joint lining (synovium). X-rays are done every few years to watch for changes. MRIs are more sensitive and show early joint changes when X-rays are normal.

Nuclear scans of the bones or joints detect synovitis in the joints or changes in the bone. A positive scan doesn’t pinpoint the type of inflammatory process. It does help show what’s going on in the joints when the patient is very obese.

Ultrasound studies called ultrasonography have several advantages. The patient is not exposed to any radiation. They show where the swelling is located and the presence of other problems such as cysts.

Doctors look to the future when patients who are at risk for RA will be identified a long time before the disease starts. Patients with a positive family history will be screened for an RA gene. By then there may be ways to prevent clinical disease. Improved technology will bring about sensitive, noninvasive imaging studies.

Is there a cure for rheumatoid arthritis (RA)? Not yet but scientists are close. This review article on RA looks at the cause and risk factors for RA. The importance of early diagnosis is discussed. Results of recent studies using drugs to put RA into remission are presented. Beyond remission, hope for a cure is outlined.

Despite all that is known about RA, we still don’t know what causes it. There may be many varied factors so that early detection based on identifying risk factors is difficult. Finding and treating the disease early can prevent long-term damage to the joints.

Scientists are studying blood tests and imaging methods to look for any clues that might guide them in screening people for RA. For example MRI may be able to detect inflammation of the joint lining (synovitis) before any joint changes show up on X-ray or are even felt by the patient.

Another problem is knowing which drugs to use to treat each patient. Some will respond to standard medications for RA. Others will need more potent drugs. Doctors have no way to know how a patient will do without a period of trial and error. The longer it takes to get the joint inflammation under control, the greater the risk for permanent damage.

Despite all these problems many patients get complete relief from symptoms. Some even have reversal of joint and bone damage. But the drugs and drug combinations used to put one person into remission don’t work for everyone.

The authors say the future “cure” of RA will depend on the earliest possible diagnosis — before any joint changes can be seen. Patients hope for a cure that doesn’t mean taking drugs for the rest of their lives.

Dr. Boden from the University of the Health Sciences in Bethesda, Maryland has written a comprehensive article on the subject of catastrophic sports injuries. Collisions in football rank number one as the most common source of traumatic injuries. Pole vaulting, gymnastics, ice hockey, and cheerleading follow.

Head and neck injuries in football are the most likely to cause permanent brain and spinal cord injuries. Most of the time the player being tackled is the one injured. Pole vaulters are at risk for head injury when the body lands on the edge of the landing pad and the head strikes the nearby concrete or asphalt. Similar injuries occur when the vaulter lands in the vault box or misses the pad and lands directly on the hard surface.

For women, cheerleading has become much more athletic with an increasing number of major injuries over the past 10 years. Fractured skulls and serious head and neck injuries occur with the pyramid and basket toss stunts when a cheerleader lands on the hard indoor gym floor.

Dr. Boden also reviews catastrophic injuries common to baseball players, soccer players, wrestlers, ice hockey players, and swimmers. Each group has their own unique type of serious injury. Safety measures and new regulations for each sport are outlined.

The author concludes that prevention is the key to avoiding these catastrophic sports injuries. More research is needed to find the right safety guidelines for each sporting activity.

Posttraumatic stress disorder (PTSD) has been reported after military service. It’s also seen after other stressful events in the civilian world. This is the first study to report on PTSD after orthopedic trauma. Only civilians at a trauma center in Denver, Colorado, were included in the study.

Researchers gave a survey to 580 patients in the trauma center. Data was collected over a three-month period of time. Most of the patients had a bad fall (195) or a car accident (162). Others were in a car-pedestrian accident or motorcycle accident. The rest had a crush injury, bicycle accident, horseback riding accident, or gunshot wound.

Researchers found a high rate of PTSD after orthopedic trauma. It was even higher than what has been reported for general trauma. The authors also report that the risk of PTSD increases with time after the injury. The patients seen at this Denver trauma center may not be the same as patients seen by other doctors. Results may vary with other types of medical centers.

The authors say that PTSD is important for two reasons. First, PTSD can negatively impact the patient’s outcome. Proper treatment is needed. Second the patient’s view of the accident or injury is just as important as the actual symptoms. PTSD can be a stronger factor in the result than even the severity of the injury.

Since PTSD is so common after orthopedic trauma, these researchers suggest that more study is needed.