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Kupeli A, Bulut E, Unver E, Danisan G. The relationship between vertebral deformities and thoracic arthropathy with back pain in Chronic Obstructive Pulmonary Disease. Int J Clin Pract 2021; 75:e14953. [PMID: 34610196 DOI: 10.1111/ijcp.14953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/13/2021] [Accepted: 10/02/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of the study was to investigate the relationship between back pain and thoracic vertebral deformities and arthropathy in patients with COPD who underwent thorax CT scans to screen for lung nodules and cancer. MATERIALS AND METHODS The data of patients who underwent thoracic CT and pulmonary function tests (PFTs) between July 2019 and February 2020 were retrospectively reviewed. The patients were divided into two groups: the COPD (n = 64) and control groups (n = 101), according to the PFT results. The CT images were evaluated for vertebral deformities, osteoporosis and thoracic vertebral joint arthropathy, and the Spinal Deformity Index (SDI) was calculated. RESULTS Back pain was detected in 43.7% of the COPD patients and 20.9% of the controls. The patients with COPD had significantly higher rates of costotransverse, intervertebral, facet joint arthropathy, and osteoporosis than did the control group (P < .001). The OR analyses showed that the presence of a vertebral deformity (OR 4.42, 95% CI 2.26 - 8.63, P < .001), of facet joint arthropathy (OR 3.6, 95% CI 2.83-4.58, P < .001), and of costotransverse arthropathy (OR 2.20, 95% CI 1.47-2.77, P < .001) were associated with the presence of back pain. Although a strong positive correlation was found between the SDI and pain score, a moderate negative correlation was found between the FEV1% values and pain score. CONCLUSIONS Back pain was present in patients with COPD and was related to vertebral deformities and facet and costotransverse joint arthropathy. Additional studies are required to clarify the relationships of back pain with musculoskeletal system diseases, including cervical and lumbar spine arthropathy and vertebral deformities.
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Affiliation(s)
- Ali Kupeli
- Department of Radiology, Faculty of Medicine, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Eser Bulut
- Department of Radiology, Faculty of Medicine, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ethem Unver
- Department of Chest Diseases, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Gurkan Danisan
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Meniscal pathologies on MRI correlate with increased bone tracer uptake in SPECT/CT. Eur Radiol 2018; 28:4696-4704. [PMID: 29789912 DOI: 10.1007/s00330-018-5466-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/11/2018] [Accepted: 04/06/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess the relationship of subchondral bone tracer uptake (BTU) on SPECT/CT and meniscal pathologies on MRI in patients with painful knees. METHODS Twenty-five patients who had MRI and SPECT/CT within 3 months without knee surgery or grade ≥3 cartilage lesions were prospectively included. Maximum values of each subchondral femorotibial area were quantified and a ratio was calculated in relation to a femoral shaft reference region, which represented the BTU background activity. Meniscal lesions were graded (intact/degeneration/tear) and meniscal extrusion (no/yes) was assessed using MRI by two musculoskeletal radiologists blinded to the SPECT/CT findings. One-tailed Spearman correlations served for statistics (p < 0.05). RESULTS Knees with meniscal degeneration or tear showed a significantly higher BTU in the medial femorotibial compartment (p = 0.045) when compared to intact menisci. Meniscal degeneration was associated with an increased BTU in the lateral femorotibial compartment; however, this was not statistically significant (p = 0.143). Patients with an extruded meniscus showed significantly higher BTU compared to a non-extruded meniscus (p < 0.020). CONCLUSIONS Medial femorotibial BTU in SPECT/CT was associated with meniscal pathologies. Highest BTU was found in patients with meniscal tears. SPECT/CT appears to be a useful imaging modality to identify patients with overloading or early osteoarthritis. KEY POINTS • Meniscal degeneration and tears correlate significantly with increased BTU using SPECT/CT. • Medial meniscus extrusion is associated with an increased BTU in SPECT/CT. • SPECT/CT allows detection of overloading and early osteoarthritis.
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Chen YW, Coxson HO, Coupal TM, Lam S, Munk PL, Leipsic J, Reid WD. The contribution of thoracic vertebral deformity and arthropathy to trunk pain in patients with chronic obstructive pulmonary disease (COPD). Respir Med 2018; 137:115-122. [PMID: 29605193 DOI: 10.1016/j.rmed.2018.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/24/2018] [Accepted: 03/02/2018] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pain, commonly localized to the trunk in individuals with COPD, may be due to osteoporosis-related vertebral deformity and chest wall hyper-expansion causing misalignment of joints between the ribs and vertebrae. The purpose of this study was to determine if thoracic vertebral deformity and arthropathy were independent contributors to trunk pain in COPD patients compared to people with a significant smoking history. METHOD Participants completed the Brief Pain Inventory (BPI) on the same day as chest CT scans and spirometry. Current and ex-smokers were separated into COPD (n = 91) or non-COPD (n = 80) groups based on spirometry. Subsequently, CT images were assessed for thoracic vertebral deformity, bone attenuation values, and arthropathy of thoracic vertebral joints. RESULTS The trunk area was the most common pain location in both COPD and non-COPD groups. Thoracic vertebral deformity and costotransverse joint arthropathy were independent contributors to trunk pain in COPD patients (adjusted OR = 3.55 and 1.30, respectively) whereas alcohol consumption contributed to trunk pain in the non-COPD group (adjusted OR = 0.35 in occasional alcohol drinkers; 0.08 in non-alcohol drinkers). The spinal deformity index and the number of narrowed disc spaces were significantly positively related to the BPI intensity, interference, and total scores significantly in COPD patients. CONCLUSION Trunk pain, at least in part, is caused by thoracic vertebral deformity, and costotransverse and intervertebral arthropathy in patients living with COPD. The results of this study provided the foundation for the management of pain, which requires further exploration.
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Affiliation(s)
- Yi-Wen Chen
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
| | - Harvey O Coxson
- Department of Radiology, and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Tyler M Coupal
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Stephen Lam
- Respiratory Division, Department of Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, Canada
| | - Peter L Munk
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- Department of Radiology and Department of Medicine, Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto Rehabilitation Institute, Interdivisional Department of Critical Care Medicine, Toronto, Canada
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Luz-Santos C, Ribeiro Camatti J, Barbosa Paixão A, Nunes Sá K, Montoya P, Lee M, Fontes Baptista A. Additive effect of tDCS combined with Peripheral Electrical Stimulation to an exercise program in pain control in knee osteoarthritis: study protocol for a randomized controlled trial. Trials 2017; 18:609. [PMID: 29268764 PMCID: PMC5740917 DOI: 10.1186/s13063-017-2332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/08/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) has been linked to maladaptive plasticity in the brain, which may contribute to chronic pain. Neuromodulatory approaches, such as Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES), have been used therapeutically to counteract brain maladaptive plasticity. However, it is currently unclear whether these neuromodulatory techniques enhance the benefits of exercise when administered together. Therefore, this protocol aims to investigate whether the addition of tDCS combined or not with PES enhances the effects of a land-based strengthening exercise program in patients with knee OA. METHODS Patients with knee OA (n = 80) will undertake a structured exercise program for five consecutive days. In addition, they will be randomized into four subgroups receiving either active anodal tDCS and sham PES (group 1; n = 20), sham tDCS and active PES (group 2, n = 20), sham tDCS and PES (group 3, n = 20), or active tDCS and PES (group 4, n = 20) for 20 min/day for five consecutive days just prior to commencement of the exercise program. The primary outcomes will be subjective pain intensity (VAS) and related function (WOMAC). Secondary outcomes will include quality of life (SF-36), anxiety and depression symptoms (HAD), self-perception of improvement, pressure pain thresholds over the knee, quadriceps strength, and quadriceps electromyographic activity during maximum knee extension voluntary contraction. We will also investigate cortical excitability using transcranial magnetic stimulation. Outcome measures will be assessed at baseline, 1 month after, before any intervention, after 5 days of intervention, and at 1 month post exercise intervention. DISCUSSION The motor cortex becomes less responsive in knee OA because of poorly adapted plastic changes, which can impede exercise therapy benefits. Adding tDCS and/or PES may help to counteract those maladaptive plastic changes and improve the benefits of exercises, and the combination of both neuromodulatory techniques must have a higher magnitude of effect. TRIAL REGISTRATION Brazilian Registry on Clinical Trials (ReBEC) - Effects of electrical stimulation over the skull and tight together with exercises for knee OA; protocol number RBR-9D7C7B. TRIAL REGISTRATION ID: RBR-9D7C7B . Registered on 29 February 2016.
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Affiliation(s)
- Cleber Luz-Santos
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Janine Ribeiro Camatti
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, São Paulo 09.080-045 Brazil
- Graduate Program in Neuroscience and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Alaí Barbosa Paixão
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Katia Nunes Sá
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Bahian School of Medicine and Public Health, Salvador, Brazil
| | - Pedro Montoya
- Research Institute on Health Sciences, University of Balearic Islands, Palma de Majorca, Spain
| | - Michael Lee
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, NSW Australia
| | - Abrahão Fontes Baptista
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, São Paulo 09.080-045 Brazil
- Graduate Program in Neuroscience and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
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van Meer BL, Oei EHG, Meuffels DE, van Arkel ERA, Verhaar JAN, Bierma-Zeinstra SMA, Reijman M. Degenerative Changes in the Knee 2 Years After Anterior Cruciate Ligament Rupture and Related Risk Factors: A Prospective Observational Follow-up Study. Am J Sports Med 2016; 44:1524-33. [PMID: 26965680 DOI: 10.1177/0363546516631936] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a well-known risk factor for development of knee osteoarthritis. Early identification of those patients at risk and early identification of the process of ACL rupture leading to osteoarthritis may aid in preventing the onset or progression of osteoarthritis. PURPOSE To identify early degenerative changes as assessed on magnetic resonance imaging (MRI) after 2-year follow-up in patients with a recent ACL rupture and to evaluate which determinants are related to these changes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Included in this study were 154 adults aged between 18 and 45 years with acute ACL rupture diagnosed by physical examination and MRI, without previous knee trauma or surgery, and without osteoarthritic changes on radiographs. A total of 143 patients completed the 2-year follow-up, and the results in this study apply to these 143 patients. All patients were treated according to the Dutch guideline on ACL injury. Of the 143 patients, 50 patients were treated nonoperatively during the 2-year follow-up period. Main outcome was early degenerative changes assessed on MRI defined as progression of cartilage defects and osteophytes in tibiofemoral and patellofemoral compartments. Patient characteristics, activity level, functional instability, treatment type, and trauma-related variables were evaluated as determinants. RESULTS The median time between MRI at baseline and MRI at 2-year follow-up was 25.9 months (interquartile range, 24.7-26.9 months). Progression of cartilage defects in the medial and lateral tibiofemoral compartments was present in 12% and 27% of patients, and progression of osteophytes in tibiofemoral and patellofemoral compartments was present in 10% and 8% of patients, respectively. The following determinants were positively significantly associated with early degenerative changes: male sex (odds ratio [OR], 4.43; 95% CI, 1.43-13.66; P = .010), cartilage defect in the medial tibiofemoral compartment at baseline (OR, 3.66; 95% CI, 1.04-12.95; P = .044), presence of bone marrow lesions in the medial tibiofemoral compartment 1 year after trauma (OR, 5.19; 95% CI, 1.56-17.25; P = .007), joint effusion 1 year after trauma (OR, 4.19; 95% CI, 1.05-16.72; P = .042), and presence of meniscal tears (OR, 6.37; 95% CI, 1.94-20.88; P = .002). When the patients were categorized into 3 treatment groups (nonoperative, reconstruction <6 months after ACL rupture, and reconstruction ≥6 months after ACL rupture), there was no significant relationship between the treatment options and the development of early degenerative changes. CONCLUSION Two years after ACL rupture, early degenerative changes were assessed on MRI. Concomitant medial cartilage defect and meniscal injury, male sex, persistent bone marrow lesions in the medial tibiofemoral compartment, and joint effusion are risk factors for degenerative changes.
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Affiliation(s)
- Belle L van Meer
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands Department of Sports Medicine, Medical Center Haaglanden, The Hague, the Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ewoud R A van Arkel
- Department of Orthopaedic Surgery, Medical Center Haaglanden, The Hague, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Harris KP, Driban JB, Sitler MR, Cattano NM, Balasubramanian E, Hootman JM. Tibiofemoral Osteoarthritis After Surgical or Nonsurgical Treatment of Anterior Cruciate Ligament Rupture: A Systematic Review. J Athl Train 2015; 52:507-517. [PMID: 25562459 DOI: 10.4085/1062-6050-49.3.89] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if surgical or nonsurgical treatment of anterior cruciate ligament rupture affects the prevalence of posttraumatic tibiofemoral osteoarthritis (OA). DATA SOURCES Studies published between 1983 and April 2012 were identified via EBSCOhost and OVID. Reference lists were then screened in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. STUDY SELECTION Studies were included if (a) treatment outcomes focused on a direct comparison of surgical versus nonsurgical treatment of anterior cruciate ligament rupture, (b) the prevalence of tibiofemoral OA was reported, and (c) they were written in English. Studies were excluded if (a) the included patients were treated with cast immobilization after surgery, (b) the mean follow-up was less than 10 years, or (c) the patients underwent anterior cruciate ligament revision surgery. DATA EXTRACTION Two independent investigators reviewed the included articles using the Newcastle-Ottawa Scale. Frequency of OA, surgical procedure, nonsurgical treatments, and participant characteristics were extracted and summarized. We calculated prevalence (%) and 95% confidence intervals for treatment groups for each individual study and overall. We developed 2 × 2 contingency tables to assess the association between treatment groups (exposed had surgery, referent was nonsurgical treatment) and the prevalence of OA. DATA SYNTHESIS Four retrospective studies were identified (140 surgical patients, 240 nonsurgical patients). The mean Newcastle-Ottawa Scale score was 5 (range = 4-6 [of 10] points). Average length of follow-up was 11.8 years (range = 10-14 years). The prevalence of OA for surgically treated patients ranged from 32.6% to 51.2% (overall = 41.4%, 95% confidence interval = 35.0%, 48.1%) and for nonsurgical patients ranged from 24.5% to 42.3% (overall = 30.9%, 95% confidence interval = 24.4%, 38.3%). CONCLUSIONS Although OA prevalence was higher in the surgical treatment group at a mean follow-up of 11.8 years, no definitive evidence supports surgical or nonsurgical treatment after anterior cruciate ligament injury to prevent posttraumatic OA. Current studies have been limited by small sample sizes, low methodologic quality, and a lack of data regarding confounding factors.
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Affiliation(s)
- Kyle P Harris
- Department of Health, Physical Education and Nursing, Bucks County Community College, Newtown, PA
| | | | - Michael R Sitler
- Department of Health, Physical Education and Nursing, Bucks County Community College, Newtown, PA
| | - Nicole M Cattano
- Department of Sports Medicine, West Chester University of Pennsylvania
| | | | - Jennifer M Hootman
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Gait metric profile and gender differences in hip osteoarthritis patients. A case-controlled study. Hip Int 2015; 24:270-6. [PMID: 24474412 DOI: 10.5301/hipint.5000111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Hip osteoarthritis (OA) is a slowly progressive destructive disease that results in alterations in joint loads and biomechanics to which patients adapt compensatory alterations and abnormal gait patterns. This prospective cross-sectional, case-controlled study examined these alterations in gait metrics and evaluated gender differences in gait spatiotemporal parameters. Correlations between function and gait metrics were also investigated. BASIC PROCEDURES Hip OA patients (138 females and 122 males) and healthy controls (14 females and 26 males) matched for age and gender underwent the same investigative protocol consisting of a spatiotemporal gait analysis followed by functional evaluations using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the SF-36 Health Survey (SF-36). MAIN FINDINGS Differences between the patient and the control groups were significant in all the spatiotemporal parameters. There were significant gender differences within the hip OA group in all parameters except for cadence and single limb support percentage. WOMAC and SF-36 scores revealed significant differences between the study and control groups in most components. Significantly higher scores in the three components of the WOMAC as well as in six SF-36 score components were found among males compared to females in the patient group. PRINCIPAL CONCLUSIONS Gait, WOMAC and SF-36 were effective objective and subjective tools for evaluating a large cohort of patients with hip OA, and can be highly useful for supplementing the assessment of hip OA severity and enhancing treatment efficacy during the course of the disease.
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Jungmann PM, Liu F, Link TM. What has imaging contributed to the epidemiological understanding of osteoarthritis? Skeletal Radiol 2014; 43:271-5. [PMID: 24346338 PMCID: PMC3925496 DOI: 10.1007/s00256-013-1783-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/28/2013] [Accepted: 11/10/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Pia M. Jungmann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Felix Liu
- Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA 94107, USA
| | - Thomas M. Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
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Shapiro LM, McWalter EJ, Son MS, Levenston M, Hargreaves BA, Gold GE. Mechanisms of osteoarthritis in the knee: MR imaging appearance. J Magn Reson Imaging 2014; 39:1346-56. [PMID: 24677706 DOI: 10.1002/jmri.24562] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 07/14/2013] [Indexed: 01/15/2023] Open
Abstract
Osteoarthritis has grown to become a widely prevalent disease that has major implications in both individual and public health. Although originally considered to be a degenerative disease driven by "wear and tear" of the articular cartilage, recent evidence has led to a consensus that osteoarthritis pathophysiology should be perceived in the context of the entire joint and multiple tissues. MRI is becoming an increasingly more important modality for imaging osteoarthritis, due to its excellent soft tissue contrast and ability to acquire morphological and biochemical data. This review will describe the pathophysiology of osteoarthritis as it is associated with various tissue types, highlight several promising MR imaging techniques for osteoarthritis and illustrate the expected appearance of osteoarthritis with each technique.
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Affiliation(s)
- Lauren M Shapiro
- Department of Radiology, Stanford University, Stanford, California, USA
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van der Esch M, Knoop J, Hunter DJ, Klein JP, van der Leeden M, Knol DL, Reiding D, Voorneman RE, Gerritsen M, Roorda LD, Lems WF, Dekker J. The association between reduced knee joint proprioception and medial meniscal abnormalities using MRI in knee osteoarthritis: results from the Amsterdam osteoarthritis cohort. Osteoarthritis Cartilage 2013; 21:676-81. [PMID: 23428600 DOI: 10.1016/j.joca.2013.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/09/2013] [Accepted: 02/08/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoarthritis (OA) of the knee is characterized by pain and activity limitations. In knee OA, proprioceptive accuracy is reduced and might be associated with pain and activity limitations. Although causes of reduced proprioceptive accuracy are divergent, medial meniscal abnormalities, which are highly prevalent in knee OA, have been suggested to play an important role. No study has focussed on the association between proprioceptive accuracy and meniscal abnormalities in knee OA. OBJECTIVE To explore the association between reduced proprioceptive accuracy and medial meniscal abnormalities in a clinical sample of knee OA subjects. METHODS Cross-sectional study in 105 subjects with knee OA. Knee proprioceptive accuracy was assessed by determining the joint motion detection threshold in the knee extension direction. The knee was imaged with a 3.0 T magnetic resonance (MR) scanner. Number of regions with medial meniscal abnormalities and the extent of abnormality in the anterior and posterior horn and body were scored according to the Boston-Leeds Osteoarthritis Knee Score (BLOKS) method. Multiple regression analyzes were used to examine whether reduced proprioceptive accuracy was associated with medial meniscal abnormalities in knee OA subjects. RESULTS Mean proprioceptive accuracy was 2.9° ± 1.9°. Magnetic resonance imaging (MRI)-detected medial meniscal abnormalities were found in the anterior horn (78%), body (80%) and posterior horn (90%). Reduced proprioceptive accuracy was associated with both the number of regions with meniscal abnormalities (P < 0.01) and the extent of abnormality (P = 0.02). These associations were not confounded by muscle strength, joint laxity, pain, age, gender, body mass index (BMI) and duration of knee complaints. CONCLUSION This is the first study showing that reduced proprioceptive accuracy is associated with medial meniscal abnormalities in knee OA. The study highlights the importance of meniscal abnormalities in understanding reduced proprioceptive accuracy in persons with knee OA.
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Affiliation(s)
- M van der Esch
- Reade, Amsterdam Rehabilitation Research Centre, 1040 HG Amsterdam, The Netherlands.
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Suri P, Dharamsi AS, Gaviola G, Isaac Z. Are facet joint bone marrow lesions and other facet joint features associated with low back pain? A pilot study. PM R 2012; 5:194-200. [PMID: 23122893 DOI: 10.1016/j.pmrj.2012.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 08/23/2012] [Accepted: 09/02/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the frequency of facet joint (FJ) bone marrow lesions, high FJ periarticular signal intensity, and FJ effusions in a convenience sample of patients with axial low back pain (LBP). DESIGN A cross-sectional pilot study with retrospective data collection. SETTING Outpatient spine clinics. PATIENTS Sixty-four adults with axial LBP scheduled to receive an FJ intra-articular corticosteroid injection. METHODS Clinical data were abstracted from the medical record by 1 physician, who was blinded to results of the magnetic resonance imaging evaluations. A musculoskeletal radiologist blinded to clinical information performed standardized assessments of the L1-S1 spinal levels for FJ bone marrow lesions, effusions, and high periarticular signal intensity on lumbar magnetic resonance imaging, including short tau inversion recovery sequences. We calculated the frequency of these FJ features and used generalized estimating equations to examine side-specific associations between the location of FJ features and the side on which LBP was experienced. RESULTS The sample included 64 participants with a mean (standard deviation) age of 59.9 ± 14.5 years. FJ bone marrow lesions were present in 64.1%, effusions in 70.3%, and high periarticular signal intensity in 65.6% of participants. All the features were most common at the L4-L5 level. These FJ features showed significant associations with the side on which LBP was experienced or statistical trends toward an association, with or without adjustment for age, gender, and body mass index. The strongest side-specific associations were seen for the number of bone marrow lesions (odds ratio [OR] 1.60 [95% confidence interval {CI},1.05-2.43]), any FJ effusion (OR 2.23 [95% CI, 1.02-4.85]), and the number of joints with high periarticular signal intensity (OR 1.75 [95% CI, 1.16-2.63]). CONCLUSIONS FJ bone marrow lesions, effusions, and high periarticular signal intensity were common in this sample of patients with axial LBP and substantially more frequent than in prior reports from unselected samples of patients with or without radicular pain. These FJ features demonstrate side-specific associations with LBP. Further study of associations between these FJ features and LBP are warranted.
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Affiliation(s)
- Pradeep Suri
- Division of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA, USA.
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HajGhanbari B, Holsti L, Road JD, Darlene Reid W. Pain in people with chronic obstructive pulmonary disease (COPD). Respir Med 2012; 106:998-1005. [PMID: 22531146 DOI: 10.1016/j.rmed.2012.03.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/06/2012] [Accepted: 03/07/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The prevalence and characteristics of pain are not known in COPD patients. The purposes of this study were to determine if pain is more common in COPD patients than in healthy people and if it was related to self-reported physical activity, health related quality of life (HRQoL) and comorbidities. METHODS Participants returned a mailed survey package that contained: 1) McGill Pain Questionnaire (MPQ) and Brief Pain Inventory (BPI) to evaluate pain severity and how pain interferes with activities; 2) Tampa Scale for Kinesiophobia (TSK) to evaluate fear of movement related to pain; 3) Short Form-36 (SF-36), to measure HRQoL; 4) Community Health Activities Model Program for Seniors (CHAMPS) to evaluate physical activity; 5) a form to list medications and comorbidities. RESULTS Forty-seven COPD patients and 47 age- and gender-matched healthy people responded. People with COPD demonstrated more pain (MPQ and BPI, p = 0.000), a greater pain-related interference in their lives (BPI, p = 0.000), a higher pain-related fear of movement, and lower frequency and energy expenditure of physical activities (CHAMPS, p = 0.000) than healthy people (TSK, p < 0.001). Pain severity (MPQ and BPI) was indirectly correlated to the Physical Component Score of the SF-36. COPD patients identified pain in the neck and trunk 3.1 times more often than healthy people. The number of comorbidities was the most consistent independent correlate of pain in COPD patients. CONCLUSIONS COPD patients demonstrate more pain which interferes with activities more so than healthy people of similar age. Pain is also negatively associated with HRQoL in COPD.
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Affiliation(s)
- Bahareh HajGhanbari
- Department of Physical Therapy, Muscle Biophysics Laboratory, Vancouver Coastal Health Research Institute, University of British Columbia, Canada V6T 1Z3.
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Chudyk AM, Ashe MC, Gorman E, Al Tunaiji HO, Crossley KM. Risk of hip fracture with hip or knee osteoarthritis: a systematic review. Clin Rheumatol 2012; 31:749-57. [PMID: 22422196 DOI: 10.1007/s10067-012-1970-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 09/16/2011] [Accepted: 02/28/2012] [Indexed: 11/29/2022]
Abstract
Osteoarthritis (OA) and hip fracture are two common musculoskeletal disorders associated with substantial societal and personal burden. The objective of this systematic review was to determine the association between hip or knee OA and risk of hip fractures in people aged 45 years and older as compared to people aged 45 years and older who do not have OA. We searched CINAHL, Cochrane Database of Systematic Reviews, Embase, OVID Medline, PUBMED, and SCOPUS for studies published up to July 2010 and conducted forward searches of included studies using Web of Science. Two reviewers independently screened articles for inclusion, extracted data, and evaluated the risk of bias of included studies using the Newcastle-Ottawa Scale. Eleven articles were included. Three investigated individuals with knee OA, two included adults with knee or hip OA, and six investigated adults with hip OA. We did not combine the hip OA or the knee OA studies in a meta-analysis due to the heterogeneity in: study populations and covariates adjusted for in estimates of association. Hip OA may be related to a decreased risk of hip fracture when considering crude estimates of association or estimates of association adjusted for a limited number of covariates, although not all studies found support for the presence of this association. The association between knee OA and hip fracture remains unclear. The presence of OA in the hip or knee should not act as an indication that assessment for hip fracture risk is unnecessary.
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Affiliation(s)
- Anna M Chudyk
- Centre for Hip Health and Mobility, Robert HN Ho Research Centre, 767-2635 Laurel Street, Vancouver, BC V6H 2K2, Canada.
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Li X, Li J, Cheng K, Lin Q, Wang D, Zhang H, An H, Gao M, Chen A. Effect of low-intensity pulsed ultrasound on MMP-13 and MAPKs signaling pathway in rabbit knee osteoarthritis. Cell Biochem Biophys 2012; 61:427-34. [PMID: 21567132 DOI: 10.1007/s12013-011-9206-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We evaluated the effect of low-intensity pulsed ultrasound (LIPUS) on MMP-13 and MAPKs expression in rabbit knee osteoarthritis (OA). For this purpose, 18 New Zealand white rabbits were randomly and equally divided into O + L, O - L, and SO groups. In O + L group, animals underwent right back leg ACLT operation and LIPUS radiation. In O - L group, animals underwent ACLT but no LIPUS treatment. In SO (control) group, animals underwent sham operation without LIPUS. After 6 weeks, we assessed the pathologic changes in the articular surface of femoral condyle and compared using Mankin scores. Also, expression of type-II collagen, MMP-13, ERK1/2, p38, and JNK was measured by Western blot. Compared with controls, Mankin scores were higher in O + L (P < 0.05)/O - L (P < 0.01) groups. Compared with O + L group, score was higher in O - L group (P < 0.05). Compared with controls, type-II collagen expression was less in O + L/O - L groups, with more significant decrease in O - L group (P < 0.05). Contrarily, expression of MMP-13, p-ERK1/2, and p-p38 was enhanced in O + L/O - L groups as compared with controls, with more significant increase in O - L group (P < 0.01). Compared with O + L group, expression was higher in O - L group (P < 0.05). We, therefore, concluded that LIPUS application promoted cartilage repair in OA through the downregulation of MMP-13, ERK1/2, and p38.
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Affiliation(s)
- Xueping Li
- Department of Rehabilitation, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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Gore M, Sadosky AB, Leslie DL, Tai KS, Emery P. Therapy Switching, Augmentation, and Discontinuation in Patients with Osteoarthritis and Chronic Low Back Pain. Pain Pract 2012; 12:457-68. [DOI: 10.1111/j.1533-2500.2011.00524.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fang MA, Heiney C, Yentes JM, Harada ND, Masih S, Perell-Gerson KL. Clinical and Spatiotemporal Gait Effects of Canes in Hip Osteoarthritis. PM R 2011; 4:30-6. [DOI: 10.1016/j.pmrj.2011.08.534] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 08/11/2011] [Accepted: 08/18/2011] [Indexed: 12/01/2022]
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Kilicarslan K, Yalcin N, Cicek H, Dogramaci Y, Ugurlu M, Ozkan H, Yildirim H. The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study. Knee Surg Sports Traumatol Arthrosc 2011; 19:932-5. [PMID: 20890699 DOI: 10.1007/s00167-010-1270-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 09/07/2010] [Indexed: 01/23/2023]
Abstract
PURPOSE The apparent synovial hypertrophy in some cases of noninflammatory knee osteoarthritis suggests that total synovectomy may provide beneficial inflammatory and pain relief after total knee arthroplasty. The aim of the study was to compare the effect of synovectomy on the postoperative pain, bleeding and functional outcome after surgical treatment of knee osteoarthritis. METHODS A total of 50 patients with bilateral, non inflammatory, primary knee osteoarthritis were included in the study. Bilateral total knee replacement was performed at the same session. Total synovectomy and total knee arthroplasty (study group) were applied to a randomly selected side, and the total knee arthroplasty alone (as control group) was applied to the contralateral side of the same patient. The overall efficacy of both procedures was assessed postoperatively by determination of blood loss from the drain, pain and functional scores. The Visual Analogue Scale of pain and the Knee Society Knee Score were used to compare the two groups at 3rd, 6th and 12th months, postoperatively. RESULTS During the postoperative 48 h, the mean blood loss in the study group (with synovectomy) was significantly higher than the control group (P=0.005). However, in the postoperative follow-up time, there was no significant difference in pain relief and in the Knee Society Score between the two groups. CONCLUSION Performing synovectomy in patients with primary knee osteoarthritis does not seem to have any clinical advantage besides it might increase blood loss and recurrent hemarthrosis postoperatively. Thus, during arthroplasty surgery, it should not be performed routinely.
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Affiliation(s)
- Kasim Kilicarslan
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Ankara, Turkey.
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Stevens-Lapsley JE, Kohrt WM. Osteoarthritis in Women: Effects of Estrogen, Obesity and Physical Activity. WOMENS HEALTH 2010; 6:601-15. [DOI: 10.2217/whe.10.38] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Arthritis is the leading cause of physical disability in the USA and osteoarthritis (OA), the most common form, affects nearly 27 million people. Women have a higher prevalence of OA than men, but the underlying causes for the increased susceptibility of women to OA are not fully understood. This review discusses the associations of sex hormones, obesity and physical activity with the incidence and progression of OA in women. Although many studies have explored the relationships of estrogen and reproductive history with the risk of OA or joint replacement, there is no consensus on the role of these factors. Obesity clearly increases risk for OA, but whether obesity affects women and men differently is uncertain. Moderate levels of physical activity do not appear to increase the incidence or progression of OA and may even have a weak protective effect. Future investigations should focus on sex-specific mechanisms for the development of OA and determine whether there are modifiable factors (e.g., estrogen, obesity, physical activity) that can be targeted through prevention and treatment strategies to mitigate the increased incidence and prevalence of OA in women.
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Affiliation(s)
- Jennifer E Stevens-Lapsley
- University of Colorado – Anschutz Medical Campus, Physical Therapy Program, Department of Physical Medicine & Rehabilitation, Aurora, CO 80045, USA
| | - Wendy M Kohrt
- University of Colorado – Anschutz Medical Campus, Division of Geriatric Medicine, Department of Medicine
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