News Category: General

Swedish scientists report a decrease in strength of healing tendons when patients use COX-2 inhibitors during the early post-operative period. The “patients” in this study were rats divided into groups. All rats had a small piece of the Achilles tendon surgically removed.

Some rats were given saline injections for the first five days after surgery. Others got parecoxib, a COX-2 inhibitor. COX-2 inhibitors are used to reduce inflammation without causing bleeding stomach ulcers. The researchers also studied two other groups of rats. Saline or parecoxib were used from day six until day 14. In a rat’s short life, this is equal to giving them COX-2 inhibitors during the later phase of healing.

Studies show that inflammation in the first few days after trauma is good. It seems to help normal repair of damaged tissue. Later in the healing process, the tissues start to remodel and form cross-links needed for strength. The authors of this study say that inflammation should be stopped in this remodeling phase. COX-2 inhibitors taken in the later phase may be helpful.

These researchers aren’t sure how to translate this information from rats to humans. Rats live a much shorter time compared to humans. A week in the life of a rat is equal to a month in humans. It’s unclear if the phases of inflammation, healing, and remodeling are the same in rats and humans.

It may be necessary to avoid COX-2 inhibitors during the first 10 days of tendon healing in humans. More study is needed to find out how these drugs affect humans in the early period after tendon injury.

This is a single case report of a 27-year-old male naval fighter pilot with a nerve injury affecting his right shoulder blade. Paralysis of the serratus anterior muscle caused the shoulder blade to stick out, a position called winging of the scapula. The patient also had arm weakness and neck and shoulder pain.

The patient couldn’t figure out what caused the problem. He hadn’t hurt himself and wasn’t doing too much weight lifting. No one in his family had ever had anything like this. There was no history of viral infection. Doctors ruled out a cartilage tear in the shoulder. MRI tests showed he hadn’t torn the rotator cuff, either.

A steroid injection to the right shoulder gave him pain relief for about an hour. However, there was no change in his weakness. EMG studies of the muscles showed a nerve palsy of the long thoracic nerve on the right side, causing the weakness of the serratus anterior muscle.

There are many possible causes of long thoracic nerve injury. Heavy packs or a sudden arm injury are the most common causes in the military. In this case, the doctors think pressure injured the pilot’s nerve during 18 consecutive takeoffs and landings in his aircraft. Pressure was put on the nerve each time the plane went from zero to 175 knots in three seconds during takeoff, or from 175 to zero in three seconds during landing. This force equals three times the gravitational pull of the earth.

It’s likely that more naval pilots have this problem. They may not report it for fear of being grounded. This case could help the military prevent and treat early any future cases of long thoracic nerve injury.

Physical therapists notice things about patients that aren’t obvious to others. For example, the authors of this study point out that patients with knee osteoarthritis (OA) often have problems with one or both hips. The authors think treating the hip may decrease knee pain and stiffness.

Two groups of patients were studied: 22 patients with knee OA, and 17 subjects with no leg problems or symptoms of arthritis. The groups were matched up as closely as possible by age and gender. A physical therapist tested each person using four special tests of the hip.

Anyone with knee OA who felt pain in the hip was treated with hip mobilizations. Treatment with mobilization is a way to gently move the joint through its range of motion without the patient’s help. The same four tests were repeated after treatment with mobilizations. Pain and range of motion were measured during each test.

The authors report that pain was reduced in all four tests after treatment. Motion was increased for two (but not all) of the tests. The results of this study show that a hip exam is a good idea in patients with symptoms of knee arthritis. The hip may be causing or adding to the knee problems. Treatment of the hip may be needed.

Back injuries are common in top tennis players. Perhaps there’s a weakness on one side of the trunk compared to the other. In this study, 109 elite tennis players were tested for rotational trunk strength on both sides.

Trunk rotation is used often during the tennis serve. It’s also needed during the forehand and backhand strokes. When a right-handed tennis player swings at the ball, the left trunk muscles contract to rotate the trunk. Just the opposite is true during the backstroke. Abdominal muscles and trunk muscles work together to hold the spine steady during these movements. This is called core stability.

Researchers doing this study hoped to find out what kind of changes occur in rotational trunk strength in top tennis players. This information may help tennis players develop the best exercise program to improve core stability.

The results showed no difference in trunk strength from side to side for the male players. This means that elite-level male tennis players have equal or symmetric strength in trunk rotation on both sides. Women had greater backhand rotation strength compared to forehand rotation. This may be because most women use two hands during the backhand stroke.

The authors conclude that special training to increase or improve trunk rotation strength may not be needed in top tennis players. The core muscles already seem to be in balance. The next step is to study injured tennis players and compare their trunk strength to uninjured players.

Sometimes neck and shoulder pain occurs, but there’s nothing wrong with the neck or shoulder. Heart attack, bleeding ulcers, and lung cancer are just a few problems that can cause pain in the neck and shoulder. Other symptoms can occur as well. These “extra” symptoms occur in situations when the tumors go beyond the lungs. The tumors then put pressure on the nearby nerves, ribs, diaphragm, or vertebrae.

In this report doctors show how standard chest and neck X-rays can be used to find Pancoast tumors early. Pancoast tumors occur in the upper part of the lung lobes. This form of lung cancer is hard to detect early. Patients often have vague symptoms that are mistaken for arthritis of the neck and shoulder or a frozen shoulder of unknown cause.

Even when an X-ray is taken, the doctor may not see early changes on X-rays unless he or she is aware of this problem. The authors of this report point out an important X-ray finding of Pancoast tumor: air in the lungs being separated from the first rib. There’s also a higher pulmonary air density seen around the tumor.

This is the first report to show the importance of X-rays in finding Pancoast tumors. Doctors must know what to look for and screen neck and shoulder pain patients appropriately.

In 1995 the American College of Sports Medicine (ACSM) wrote a position stand on Osteoporosis and Exercise. This new report on Physical Activity and Bone Health replaces the old report.

The ACSM reminds us that regular physical activity can help keep bones healthy in adults. The risk of bone fracture is also reduced, and it doesn’t take vigorous activity to do it!

To build bone in children and teens, physical activities that include running and jumping may be best. Exercise is advised at least three days a week for 10 to 20 minutes.

To prevent bone loss in adults, weight-bearing and resistance activities are best. These activities include walking alternating with jogging, stair climbing, tennis, and weight lifting. Moderate to high intensity is needed to apply enough force to the bones to stimulate bone growth and repair.

Exercise for adults should be 30 to 60 minutes long. Weight-bearing activities should be done three to five times each week. Weight lifting should be done two to three times each week. All major muscle groups should be exercised.

This report gives a prescription of exercise to help build up bone density in children and preserve bone density in adults. Type of exercise, intensity, frequency, and duration are all discussed. The needs of much older adults are also addressed. The ACSM advises older adults to exercise to preserve their bones and keep their balance. The goal is to prevent falls and fractures.

Can you rub your belly and pat your head at the same time? How about walk and talk at the same time? Being able to talk while exercising is a simple way to make sure you get all the benefits of the program without the risks. So say researchers at the University of Wisconsin-La Crosse.

Sixteen healthy volunteers (men and women) were tested on a treadmill and a bike. Heart rate and breathing metabolism were measured. All subjects were asked to exercise at a comfortable level, so that they could talk at the same time. This is called the Talk Test.

Using the Talk Test as a measure of exercise intensity, the researchers found that subjects used the same amount of oxygen on the bike and the treadmill. They conclude that the Talk Test is a good way to prescribe the right level of exercise in a variety of settings.

The Talk Test is a good tool to find the best level of exercise intensity when expensive exercise testing isn’t possible.

Recovery after hip or knee replacement varies from patient to patient. Some can go from the hospital directly home. Others need some extra time in the hospital with help from the physical therapist. And a few will need extended rehab.

Knowing the outcome ahead of time could help family members prepare better for the patient’s care. There’s a new tool used to help measure risk and predict where the patient will end up. It’s called the risk assessment and prediction tool (RAPT). Risk is based on age, gender, and ability to get around without help.

Older females who are housebound and need someone to care for them after the operation are at greatest risk. Younger men who don’t rely on walking aids and don’t need meals on wheels or live-in care after the operation have the lowest risk.

This study shows that using the RAPT before surgery works well to find patients who will need the most help after hip or knee joint replacement. Patients with low risk went directly home while patients with greater risk were treated with in-hospital physical therapy.

Hospital records over time showed that more patients went directly home when the RAPT was used. There was no increase in the number of patients who were readmitted to the hospital later. The authors conclude that use of the RAPT can help reduce health care costs associated with hip or knee joint replacements.

Pain after surgery can be a big problem. In this study, doctors used a small, portable pump after surgery for three children. The pump allowed the patients to go home with good pain control. It also made it possible for the children to complete their physical therapy (PT) sessions.

Until now, patient-controlled analgesia (PCA) was only used for adults. The pump was large and heavy, with very advanced technology. The unit used in this study was lightweight and fit easily inside a small pouch. It was battery operated. Parents could change the program at home with instructions from the doctor.

The main goal in getting such good pain control was to complete the PT program everyday. The PCA was used for the first three days. No other pain medication was needed during that time. PT was carried out with little to no pain. Rehab is very important in the success of many operations.

The authors point out that in-home use of PCA is experimental at this time. Routine use can’t be prescribed until safe doses can be determined.

True or false: Stretching should always be done before exercising. False! Stretching has generally been advised to improve physical performance. But new studies show that stretching may actually decrease muscle force and power, leading to worse physical performance.

This is the first study to look at the effects of acute stretching on balance, joint position sense, and movement time. Sixteen young, healthy male college students were studied. The stretching program under review included stretches of three muscle groups in the legs. The muscles stretched were the quadriceps, hamstrings, and calf muscles. Everyone rode a bicycle for five minutes to warm up. Then they stretched each muscle for 45 seconds. Each stretch was done three times.

The results showed stretching to the point of discomfort decreases the muscle’s ability to respond when needed. Balance, recovery from loss of balance, and speed of movement were all decreased after stretching. This study agrees with other studies that show warm-up exercise has a better effect on performance than stretching.

Improving balance and reaction time can help the athlete as well as the aging adult at risk for fractures from falls. It may be better to do general and more specific warm-ups related to the activity than to stretch first. Stretching is still important but shouldn’t be done right before athletic events or other activities.

Many Americans are using supplements of all kinds to treat or prevent various illnesses and diseases. Some products are used to improve memory, immune function, and joint lubrication. Others are thought to prevent depression and colds. In this report, two pharmacists review 10 of the most common herbal products. They present the effects these herbs have on patients planning to have orthopedic surgery.

Most herbal supplements have some possible problems when used around the time a patient is having surgery. For example, gingko biloba is used to improve memory. But it can also increase the risk for bleeding. The gingko keeps platelets from clumping together so they can’t form a clot.

Ginseng is used to prevent the effects of aging. It’s also reported to increase energy. This is another herb that can prevent blood clotting. It also lowers blood glucose levels after eating. This leaves a person at risk for low energy and falls.

Most doctors tell patients to stop using herbs or supplements at least two weeks before surgery. Some products can be used up to 48 hours before an operation. Others must be stopped slowly to prevent withdrawal. Doctors will be able to set more specific times as information about these herbs becomes available.

These pharmacists suggest that patients always tell their doctors all drugs, medications, and herbs they are using before having surgery. Doctors must know the effects of each product and advise patients about using or avoiding these herbs.

Low back pain (LBP) from a disc problem occurs in patients no matter what insurance coverage they have. But diagnosis and treatment may be based on their insurance coverage.

This study compares patients with LBP in two groups. One group had been in a car accident. They could see any doctor they chose under a personal injury program (PIP). The second group had a work-related injury. They were managed under a worker’s compensation (WC) program. The WC group sent patients to a group of approved doctors.

In the PIP group, treatment and reimbursement depends on getting approval for treatment in advance. This is called preauthorization. In cases of lumbar disc problems, this approval often depends on the patient having a positive straight leg raise (SLR) test. The SLR test is a reliable test. A positive SLR test on one side is called unilateral SLR. A positive SLR test on both sides is a bilateral SLR.

A review of 200 patient charts was done. A higher percentage of people with a positive SLR was seen in people covered by a PIP than by WC. Here are the results:

This article gives some important reminders about treating the older adult with bone and joint problems. Age-related changes in how the body functions are reviewed. Special problems in older adults are noted. A few simple rules are offered to prevent these problems.

Blood pressure goes up. Body temperature goes down. Skin gets thinner and bruises easier. Changes in vision and hearing occur. All these factors put the older adult at increased risk for problems after an operation.

The older adult is more likely to be taking drugs for various problems. Often patients over 65 years old are taking multiple drugs. They may be taking over-the-counter drugs and herbal remedies, too. This report offers doctors guidelines for how to adjust doses for many drugs used to treat older adults. A general rule in giving drugs to older patients is to “start low and go slow.”

Delirium is a common problem during a hospital stay for hip fracture. This problem can be prevented. The article offers some easy-to-follow advice. Keep a calendar and a clock in the patient’s room. Make sure the room is well lit during the day, with nightlights during dark hours. Prevent dehydration. Make sure patients have their eyeglasses and hearing aids.

The patient’s rights are also reviewed. Patients must be given choices. They shouldn’t be forced to choose treatment they don’t want. Advice from family members, a team approach, and using a living will help patients decide what care they do want.

The author suggests taking extra time with the older adult needing medical care. Ways to prevent, treat, and manage problems are reviewed in this report.

Osteoporosis affects women four times more often than men. Still, there are two million men in the United States with this disease. And this figure is expected to increase as men live longer. This article reviews osteoporosis in men.

New research shows that estrogen is needed by both men and women to keep bone mass. Without good bone density, adults are at risk for fractures, especially hip fractures. In this report, doctors discuss the role of hormones, genetics, and treatment for osteoporosis in men compared to women.

Scientists aren’t sure yet exactly how hormones work in men. It’s not clear what goes wrong. Maybe there is an imbalance of hormones. This can cause an increase in bone loss after the bone is formed. Or perhaps not having the right hormones keeps the bone from forming in the first place.

Genetics also plays a role in male osteoporosis. Men with osteoporosis are likely to have other male relatives with this disease.

Treatment begins with prevention. Bone density must be built in young boys through calcium intake and physical activity. Men at risk for osteoporosis must be identified. Risk factors for osteoporosis such as smoking, inactivity, and poor diet can be changed. Alcoholism, low calcium, and low vitamin D are also risk factors for low bone mineral density. Vitamin D comes from sunshine.

Drug treatment is another option for men with osteoporosis. One option is a drug called Alendronate. It used to prevent bone loss once the bone is already formed. Low doses of parathyroid hormone (PTH) can be given off and on. PTH is a bone-forming drug. Fluoride may be useful to boost bone growth, too. Researchers are studying this closely.

The authors conclude that osteoporosis occurs in men slowly over time. Bone loss is highest in men with low levels of hormones such as testosterone and estrogen. Clear guidelines for screening men for osteoporosis aren’t ready yet. This report suggests that screening should begin with men who have already had bone fractures. Screening should also be done for men over 75 and men who are alcoholics.

Many patients could use a joint replacement. Often they refuse to even think about it. What’s the hold up? That’s what researchers in Canada set out to discover. This study focused on 17 adults with moderate to severe arthritis. All were good candidates for joint replacement. All were unwilling to consider it.

The patients were interviewed and asked questions in two key areas. The first was about the information they had received about the operation. Questions were also included to find out what kind of support patients expected if they had the surgery. The second area addressed the needs and desires that were important to the patients. These questions focused on arthritis management and care after joint replacement.

The researchers used the patients’ answers to understand what decision-making process is used. Did the individuals weigh the risks and benefits of joint replacement? Did they compare all treatment options?

The authors report that no one single event made people decide about joint replacement. It’s more likely that a slow increase in pain and loss of function are the key factors. Patients are less likely to think about a joint implant if the pain comes and goes. The same is true if they have some function and can get around despite the pain.

The decision to have a joint replacement is complex. For many patients it’s more than just looking at the pros and cons. People consider many factors and use information from many sources. For example, even with severe pain and disability, many patients don’t think their situation is bad enough for surgery. Or they’ve heard there’s even more pain after the operation. Some don’t see the value given their own limited life span.

Most patients rely on their friends and peers to tell them about the operation. The authors of this report suggest this means patients may not get accurate information about their own case. Understanding how patients make this decision may help doctors guide patients in their treatment.

The topic of this report is how and why joint trauma leads to arthritis. Arthritis that develops after an injury is called posttraumatic arthritis. The authors review what is already known on this topic. They ask: Is this type of arthritis brought on by joint instability or joint incongruity?

Incongruity occurs when two sides of the bone or joint don’t line up smoothly and evenly. Incongruity can be caused by a bone fracture or an injury to the joint. Instability means the joint is free to move too far in one or more directions. Many studies show that patients do pretty well when the joint is stable, even if there is a lot of incongruity. On the other hand, even a small amount of incongruity causes problems when the joint isn’t stable.

Is there a link between joint incongruity and posttraumatic arthritis? Here’s what we know so far:

Chronic groin pain during exercise can be hard to diagnose. This report sheds some light on sports hernia as the most common cause of groin pain among athletes. A hernia is defined as a weakness of the abdominal wall. Part of the bowel pushes through an opening in the weak area, forming the hernia.

Sports hernia refers to a particular kind of hernia and the fact that pain occurs during sports activities. The exact problem isn’t clear and may differ from player to player. Doctors say weakness of the tissues around the inguinal canal leads to tears and separation of the tissues. The inguinal canal is formed by fascia to the abdominal muscles on one side and the internal oblique abdominal muscle on the other. Inside the canal is the spermatic cord in men and the round ligament in women.

In this study, 14 players had undiagnosed groin pain for three months or more. Rest and conservative treatment didn’t help. The pain kept the athletes from their sport, work, or exerting themselves. Other symptoms included only local tenderness. There was no swelling.

X-rays and imaging studies failed to show the cause of the problem. Doctors did surgery to look inside the abdomen. The doctors used an endoscope, a special tool with a light on the end, to look inside the abdomen. In all but three cases, the patients had a sports hernia. The three other patients had a fatty tumor called a lipoma. Surgery was done to repair the hernia or remove the tumor.

The authors report that 13 patients were able to return to full activity. All 13 were able to return to their sporting activity within three months. The researchers recommend an endoscopic exam in any athlete with groin pain of unknown cause. During the endoscopy any damage found can also be repaired at the same time, saving time and money.

In this study, ultrasound (US) was used and compared in two different ways to treat one-sided neck pain in 72 patients. US is a form of heat energy generated in the muscles and soft tissues. It’s applied through the skin with a special machine.

All patients in the study had shoulder and neck trigger points and pain on one side. Trigger points are irritable spots in the muscle that cause pain and spasm.

The control group had standard US over the area of pain. The applicator was moved in small circles over the area. Each treatment lasted five minutes. In the study group, high-power pain threshold (HPPT) US was used. In this method the US was turned up to the point patients could feel pain. Then it was turned down to half the intensity. This cycle was repeated three times. The probe was held motionless over the trigger point.

The authors report the results of these two methods using pain and neck range of motion as measures. Patients were followed for one month. US done with HPPT reduced pain much faster than standard US. Range of motion was equal in both groups after treatment.

The researchers suggest that HPPT may save money since fewer treatments are needed. This method is painful, but the pain intensity can be controlled by the physical therapist applying the US.

Tai chi chun (TCC) exercise can help slow bone loss in postmenopausal women. This is the conclusion of a study from the Hong Kong Center for Osteoporosis Care. And it’s good news, since bone loss is a major risk factor for fractures in women after menopause.

TCC is a low-impact exercise popular with many older adults. It’s made up of slow, gentle movements of the entire body. It’s performed in the standing position, making it a weight-bearing exercise. It’s also been shown to improve many aspects of health, such as balance, strength, and motor control.

In this study, 132 women were divided into two groups. Group one followed a program of regular exercise. TCC (Yang style) was done five days each week (45 minutes each day) for one year. The control group did not do any type of exercise.

Bone mineral density in the weight-bearing bones was measured in each woman before the study started. It was measured again 12 months later. The number of bone fractures was also recorded.

The authors report that a general bone loss occurred in both groups. This bone loss was greater in the control group. Bone loss occurred at a slower rate in the TCC group.

The authors conclude that TCC is a good exercise for older people to help prevent osteoporosis. It slows bone loss and decreases the risk of falls and fractures. Overall quality of life is improved, too. These changes come about because TCC increases range of motion, endurance, and strength. Less pain and better posture are added benefits.

Female athletes are at greater risk for leg injuries than males. Scientists think weakness of the core muscles is to blame. Core strength refers to the muscles around the pelvis and low back area, including the abdominal, hip, and trunk muscles. Researchers at the University of Delaware have something to say about this theory.

Physical therapists measured the difference in core strength between males and females. They also looked for any links between core stability in injured and uninjured athletes. All the athletes were involved in basketball or track. Everyone was tested two weeks before practice started. They were followed until the end of the season. The report explains each test done and the position used to test core muscles. The number of injuries and days lost due to injury were recorded for each athlete.

The authors reported on the core stability measurements between men and women. They also compared results of injured and uninjured athletes. The results show that 35 percent of women were injured, compared to 22 percent of men. Some athletes had more than one injury. The average time to return to play was about one week.

Findings also included: