Abstract
IntroductionSubstantial weakness of the quadriceps muscles is typically observed in patients with arthritis. This is partly due to ongoing neural inhibition that prevents the quadriceps from being fully activated. Evidence from animal studies suggests enhanced flexion reflex excitability may contribute to this weakness. This prospective observational study examined the effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps muscle strength and knee pain in individuals with knee synovitis.MethodsSixteen patients with chronic arthritis and clinically active synovitis of the knee participated in this study. Knee pain flexion reflex threshold, and quadriceps peak torque were measured at baseline, immediately after knee joint aspiration alone and 5 ± 2 and 15 ± 2 days after knee joint aspiration and the injection of 40 mg of methylprednisolone acetate.ResultsCompared to baseline, knee pain was significantly reduced 5 (p = 0.001) and 15 days (p = 0.009) post intervention. Flexion reflex threshold increased immediately after joint aspiration (p = 0.009) and 5 (p = 0.01) and 15 days (p = 0.002) post intervention. Quadriceps peak torque increased immediately after joint aspiration (p = 0.004) and 5 (p = 0.001) and 15 days (p <0.001) post intervention.ConclusionsThe findings from this study suggest that altered sensory output from an inflamed joint may increase flexion reflex excitability in humans, as has previously been shown in animals. Joint aspiration and corticosteroid injection may be a clinically useful intervention to reverse quadriceps muscle weakness in individuals with knee synovitis.
Highlights
Substantial weakness of the quadriceps muscles is typically observed in patients with arthritis
A number of experimental studies [10,11,12] have demonstrated that joint effusion is an important cause of arthrogenic muscle inhibition (AMI), with immediate reductions in quadriceps peak torque, electromyography (EMG) amplitude and H-reflex amplitude observed following the infusion of normal saline into healthy, uninjured knee joints
Recent studies have demonstrated that experimental knee pain leads to an immediate reduction in quadriceps peak torque [17, 18], voluntary muscle activation [17] and H-reflex amplitude [17], suggesting that joint nociception plays an important role in quadriceps AMI
Summary
Substantial weakness of the quadriceps muscles is typically observed in patients with arthritis. Recent studies have demonstrated that experimental knee pain leads to an immediate reduction in quadriceps peak torque [17, 18], voluntary muscle activation [17] and H-reflex amplitude [17], suggesting that joint nociception plays an important role in quadriceps AMI. Both these mechanisms may be relevant to arthritic joint disease, where joint effusion is often perennial and the presence of inflammatory mediators substantially increases nociceptive discharge by ongoing peripheral sensitisation of group III and IV joint afferents (for a review see [19])
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