Joint Pain Syndrome Research Articles

Clinical implications of persistent joint pain after gout flare

ObjectivesA subset of gout patients developed persistent joint pain after flares. Analysis of this clinical phenomenon may shed further light on the factors related to worsening gout and even provide clues to its pathogenesis. MethodsWe analyzed the clinical, laboratory, and ultrasound data of gout patients to explore the associations of these data with persistent joint pain after gout flares. ResultsA total of 1029 gout patients were included: 182 (17.7%) patients with persistent joint pain and 847 (82.3%) patients with nonpersistent joint pain. Patients with persistent joint pain had more total involved joints, more gout flares in the past year, and more joints with simultaneous gout flares (P<0.01). Among the ultrasound-detected lesions, patients with persistent joint pain had a higher incidence of tophus (36.4% vs. 21.1%) and bone erosion (18.6% vs. 8.6%) (P<0.05). Higher UA and lower TBil were found in patients with persistent joint pain (P<0.001). Hypertension (54.9% vs. 38.7%) and metabolic syndrome (58.8% vs. 46.4%) were both more frequent in patients with persistent joint pain (P<0.05). TBil was negatively correlated with the incidence of persistent joint pain (P<0.001, r=−0.190), UA values (P<0.001, r=−0.125), and metabolic syndrome scores (P<0.001, r=−0.192). A correlation curve was fitted using LOESS (locally weighted region). ConclusionPersistent joint pain after gout flares is a marker of increased disease burden in gout. The significance of the level of total bilirubin for the exacerbation of gout deserves further study.

Clinical implications of persistent joint pain after gout flare

ObjectivesA subset of gout patients developed persistent joint pain after flares. Analysis of this clinical phenomenon may shed further light on the factors related to worsening gout and even provide clues to its pathogenesis. MethodsWe analyzed the clinical, laboratory, and ultrasound data of gout patients to explore the associations of these data with persistent joint pain after gout flares. ResultsA total of 1029 gout patients were included: 182 (17.7%) patients with persistent joint pain and 847 (82.3%) patients with nonpersistent joint pain. Patients with persistent joint pain had more total involved joints, more gout flares in the past year, and more joints with simultaneous gout flares (P<0.01). Among the ultrasound-detected lesions, patients with persistent joint pain had a higher incidence of tophus (36.4% vs. 21.1%) and bone erosion (18.6% vs. 8.6%) (P<0.05). Higher UA and lower TBil were found in patients with persistent joint pain (P<0.001). Hypertension (54.9% vs. 38.7%) and metabolic syndrome (58.8% vs. 46.4%) were both more frequent in patients with persistent joint pain (P<0.05). TBil was negatively correlated with the incidence of persistent joint pain (P<0.001, r=−0.190), UA values (P<0.001, r=−0.125), and metabolic syndrome scores (P<0.001, r=−0.192). A correlation curve was fitted using LOESS (locally weighted region). ConclusionPersistent joint pain after gout flares is a marker of increased disease burden in gout. The significance of the level of total bilirubin for the exacerbation of gout deserves further study.

Effect of Low Level Laser Therapy Vs Ultrasound Therapy in The Management of Temporomandibular Joint Pain Syndrome

The temporomandibular joint is a synovial joint made up of articulating surface of the temporal bone and the head of the mandible.Patients suffering from temporomandibular joint pain syndrome will frequently have pain in the region, limitation in opening, asymmetrical jawmovements, and restricted jaw movements. The etiology is associated with several factors, including malocclusion, trauma, emotional stress,and para-functional habits, which cause excruciating pain and inflammation of the surrounding muscle, posterior fibers, and synovial fluid. Thisstudy evaluated and compared the effectiveness of low-level laser therapy (LLLT) and ultrasound therapy (UST) in managing temporomandibularjoint pain syndrome. This experimental study of pre and post-comparative types involves 30 subjects with temporomandibular joint painsyndrome who were selected from the outpatient department. This study included 30 subjects divided into two groups of each 15 by simplerandom sampling method.15 sessions each alternate day of low-level laser therapy (GROUP A) and ultrasound therapy (GROUP B) wereadministered to the affected side. Both groups received stretching exercises as a common intervention. Group A received low-level lasertherapy along with stretching exercises for 7 sessions /week/10 min. Group B received ultrasound therapy and stretching exercises for 7sessions /one weeks/10 min. On comparing the mean values of Group A &amp; Group B on the Visual Analogue Scale Score in terms of painintensity, it shows a significant decrease in the post-test mean values in both groups, but (Group A - Low-level Laser Therapy) shows 2.33,which has the lower mean value is more effective than (Group B - Ultrasound Therapy) 3.53 at P ≤ 0.001. Hence the null Hypothesis isrejected. On comparing the pre-test and Post-test between Group A &amp; Group B on VAS Score, Group A shows a highly significant difference inmean values at P ≤ 0. 001. Thus, we conclude that low-level laser therapy is more effective than ultrasound therapy in the management oftemporomandibular joint pain syndrome.

Dynamics of disability and pain indicators under the influence of physical therapy for adhesives capsulitis and myofascial pain syndrome.

Aim: To compare the effectiveness of end-range mobilization and therapeutic exercises, used in combination with ischemic compression, on disability and pain indicators among patients with adhesive capsulitis of the shoulder joint and thoracic myofascial pain syndrome. Materials and Methods: The study involved 68 patients. Goniometry of the shoulder joint, assessment of pain in myofascial trigger points, and the Shoulder Pain and Disability Index questionnaire were used before and after physical therapy. The duration of physical therapy comprised 3 weeks. Physical therapy of the first group of patients consisted of end-range mobilization and ischemic compression. Patients of the second group performed therapeutic exercises and ischemic compression. Results: Both groups demonstrated positive dynamics of shoulder joint mobility, Shoulder Pain and Disability Index and pain in trigger points. However, the final results of the studied indicators were better in the first group of patients. Conclusions: Physical therapy based on the combination of end-range mobilization and ischemic compression had a more positive impact on disability and pain indicators for adhesive capsulitis of the shoulder joint and myofascial pain syndrome as compared to the combination of therapeutic exercises and ischemic compression.

Facet joint disorders: from diagnosis to treatment.

One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of chronic spinal pain syndromes, respectively. Common facet joint disorders are degenerative disorders, such as osteoarthritis, hypertrophied superior articular process, and facet joint cysts; septic arthritis; systemic and metabolic disorders, such as ankylosing spondylitis or gout; and traumatic dislocations. The facet pain syndrome from osteoarthritis is suspected from a patient's history (referred pain pattern) and physical examination (tenderness). Other facet joint disorders may cause radicular pain if mass effect from a facet joint cyst, hypertrophied superior articular process, or tumors compress the dorsal root ganglion. However, a high degree of morphological change does not always provoke pain. The superiority of innervating nerve block or direct joint injection for diagnosis and treatment is still a controversy. Treatment includes facet joint injection in facet joint osteoarthritis or whiplash injury provoking referred pain or decompression in mass effect in cases of hypertrophied superior articular process or facet joint cyst eliciting radicular pain. In addition, septic arthritis is treated using a proper antibiotic, based on infected tissue or blood culture. This review describes the diagnosis and treatment of common facet joint disorders.

Dynamics of clinical manifestations of gonarthritis in overweight hypertensive women under the influence of complex therapy

The aim of the work was to study the dynamics of clinical manifestations of gonarthritis in women with hypertension and overweight under the influence of complex therapy. Materials and methods. A two-stage study was conducted on the effectiveness of Rosuvastatin and Arginine in the complex therapy for patients with gonarthritis in combination with hypertension and excess body weight. At the first stage, on the basis of the inpatient Rheumatology Department, 198 women hospitalized in the period 2018–2020 were prospectively examined after receiving their informed consent. The follow-up study of the second stage (2019–2021) was carried out at the outpatient department. At the follow-up stage, 134 women were examined. Depending on the accompanying pathology, the patients were divided into three groups. Results. The use of the proposed treatment option in the complex treatment for selected contingent of patients contributed to a significant reduction in the proportion of patients with movement restriction in Group 2 and Group 3 by 62.21 % and 52.12 %, pain during active movements by 24.89 % and 52.12 % and swelling of the joints by 13.8% and 12.65 %, respectively; a decrease in IL-6 levels in Group 2 and Group 3 by 3.64 and 1.36 times, CRP by 1.97 and 1.12 times, and an increase in IL-10 by 3.57 and 1.62 times, respectively; improvements in WOMAC scores in all studied groups with a significant increase in Group 2 and Group 3. Conclusions. The combination of Rosuvastatin 20 mg per day for the 3-month course and Arginine 100 ml intravenously No. 10 with subsequent oral administration of 5 ml 4 times daily for 1 month has been found to increase the effectiveness of treatment for patients with gonarthritis combined with hypertension and overweight, reduce the intensity and duration of joint pain syndrome and significantly improve the functional capacity of joints.

A comparative study of the efficacy of instrument-assisted soft tissue mobilization and massage techniques in patients with patellofemoral joint pain.

The aim of this study was to compare the clinical efficacy of instrument-assisted soft tissue mobilization (IASTM) and manipulative therapy Tui-na techniques in the treatment of patients with patellofemoral joint pain syndrome, and to evaluate their impact on pain relief, functional improvement, and joint range of motion. In this study, 25 patients with patellofemoral pain syndrome were enrolled, comprising of an intervention group of 13 patients who received IASTM treatment and a control group of 12 patients who received Tui-na manipulation therapy. The treatment cycle lasted for 4 weeks, featuring two interventions per week. Before treatment, the visual analog pain scale (VAS) of the knee, Lysholm score of the knee, modified Thomas test (MTT), and maximum isometric strength of the extensor muscles of the lower limbs were measured and recorded for both groups. After the first and last treatments, the aforementioned indexes were reassessed, and the maximum isometric muscle strength of the lower extremity extensors was measured only after 4 weeks of treatment had been completed. There was no significant difference in the basic information of the two intervention groups (p > 0. 05). After the first treatment and 4 weeks of treatment, the Lysholm score in both groups significantly improved (p < 0. 05), indicating that both interventions can improve the function of patients' lower limbs. However, the Lysholm score in the IASTM group significantly increased compared with that of the massage group after 4 weeks of treatment, indicating that its improvement in functional performance is superior. Both groups showed significant improvement in knee joint pain after the first treatment and 4 weeks of treatment (p < 0. 05), with the IASTM group having a lower VAS score and better pain improvement after 4 weeks of treatment. The strength of the two intervention groups significantly increased after the maximum isometric muscle strength test of the lower limb extensor muscles before and after 4 weeks of treatment (p < 0. 05). After the MTT test, the extension angle, deviation angle, and hip abduction angle of the tested legs in the two intervention groups were significantly reduced (p < 0. 001), indicating an improvement in lower limb joint mobility. Instrument-assisted soft tissue mobilization treatment and Tui-na manipulation therapy significantly reduced pain, improved knee flexibility, and increased range of motion of the lower extremity in patients with PFPS. However, IASTM treatment significantly improved pain and function and sustained pain in the short to medium-term post-trial period. www.isrctn.com, ISRCTN88098928.

Forsythoside B alleviates osteoarthritis through the HMGB1/TLR4/NF-κB and Keap1/Nrf2/HO-1 pathways.

Osteoarthritis (OA) is a joint pain and dysfunction syndrome resulting from severe joint degeneration. Inflammation and degeneration of the articular cartilage are two main features of OA and have tight interactions during OA progression. Conventional treatment with nonsteroidal anti-inflammatory drugs has been widely utilized clinically, whereas the side effects have restricted their application. Forsythoside B has been found with anti-inflammatory effects and antiapoptosis in inflammatory diseases, whereas in OA it remains poorly understood. Interleukin (IL)-1β (10 ng/mL) was taken to induce an OA cell model on HC-A chondrocytes and an OA rat model was constructed for in vivo experiments. Forsythoside B was adopted to treat HC-A chondrocytes and OA rats. As shown by the data, Forsythoside B hampered IL-1β-elicited rat chondrocyte apoptosis, oxidative stress, and facilitated proliferation. The profiles of inflammatory factors, NOD-like receptor family pyrin domain containing 3 inflammasomes, Kelch-like epichlorohydrin-associated protein-1 (Keap1), and nuclear factor-κB (NF-κB) phosphorylation were suppressed by Forsythoside B, whereas the nuclear factor E2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) levels were promoted. Further, Forsythoside B mitigated cartilage damage and degeneration. Moreover, the oxidative stress and inflammation mediators in the cartilage tissue of OA rats were remarkably abated. Collectively, Forsythoside B hinders the NF-κB and Keap1/Nrf2/HO-1 pathways to curb IL-1β-elicited OA rat oxidative stress and inflammation both in vivo and ex vivo, ameliorating OA development. All over, this study provides an underlying strategy for treating OA, which might help the clinical treatment of OA patients.

EVALUATION OF THE THERAPEUTIC ALLIANCE IN PATIENTS WITH ADHESIVES CAPSULITIS AND MYOFASCIAL PAIN SYNDROME AFTER PHYSICAL THERAPY

Abstract. The purpose of the study: to investigate the therapeutic alliance that is formed during physical therapy based on therapeutic exercises and ischemic compression in patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome in the thoracic region.&#x0D; Materials and methods. 20 patients participated in the study. None of the patients had a history of intra-articular corticosteroid injections prior to the orthopedic physician's consultation, while 7 (35%) patients received the injection after the physician's consultation prior to physical therapy. Physical therapy began after an examination and consultation with an orthopedic traumatologist. Patients received a physical therapist's consultation, during which they were given information about the specifics of performing therapeutic exercises and ischemic compression of trigger points at home through instruction, demonstration, and trial performance. The patient also received an information booklet. Later, exercises and ischemic compression were performed at home independently. The complex of therapeutic exercises included pendulum exercises and stretching exercises, which were aimed at the shoulder joint and did not aim to move the scapulothoracic joint. Planned counseling of patients by a physical therapist also took place at the beginning of the 2nd and 3rd week of therapy, and the final one at the end of the 3rd week. At all consultations, in addition to providing and clarifying information about physical therapy, information was also received from the patient about the presence of questions, thoughts and feelings related to physical therapy to prevent the existence of unanswered questions and unexpressed thoughts.&#x0D; Goniometry of the shoulder joint and assessment of pain on a numerical scale at trigger points (when applying pressure of 2.5 kg×cm-2) were used before the intervention and after three weeks of physical therapy. The first assessment of the therapeutic alliance was conducted after three weeks of physical therapy, and the second 1.5 months after the first questionnaire.&#x0D; Results. In the course of physical therapy, the indicators of movement amplitudes improved and pain in trigger points decreased statistically. The first assessment of the therapeutic alliance established that the Mе (25%; 75%) indicators of the goal domain were 16 (15; 17) points, the task domain was 15 (14; 17) points, the relationship domain was 16 (15; 17) points, and re-evaluation did not establish changes in key indicators in the distant period. The goals domain scores decreased slightly, while the task and relationship domains increased slightly. Statistical differences were established only in the eighth (in favor of the first questionnaire), ninth and twelfth points of the questionnaire (in favor of the second questionnaire).&#x0D; Conclusions. Physical therapy, which consisted of a series of consultations and independent performance of therapeutic exercises and ischemic compression, had a positive effect on the range of motion in the shoulder joint and pain in trigger points. During the three-week participation in the physical therapy program, a therapeutic alliance was formed, which the patients rated at the level of 47 (46; 48) points, and the remote assessment did not establish its changes over time.

Infl uence of osteopathic correction on range of motion and quality of life in patients with arthrosis of the shoulder joint of I–II degrees

Introduction. Shoulder pain in the shoulder joint arthrosis is a diffi cult problem to treat. The search for effective therapy of the shoulder region pathology is an urgent medical and socio-economic task, since the peak of morbidity is during the period of active human labor activity — 40 years. As a rule, nonsteroidal anti-infl ammatory drugs and glucocorticoid drugs are used to treat patients with shoulder pain syndrome and arthrosis of the shoulder joint of I–II degrees, but it is associated with potential risk of adverse reactions. Therefore, the search for non-drug methods of treatment is in demand. Osteopathic correction has proven itself well in the complex therapy of a number of degenerative joint diseases and pain syndrome. At the same time, there are currently few works devoted to the problem of restoring function in the shoulder joint and the life quality of a patient with the shoulder joint arthrosis of I–II degrees from the position of osteopathic correction. The aim of the study was to investigate the effect of osteopathic correction on the motion range and life quality of patients with the shoulder joint arthrosis of I–II degrees.Materials and methods. The study involved 26 patients with arthrosis of the shoulder joint of I–II degrees. The study was conducted from January 2020 to December 2021 at the «Tuya» Center of Traditional Medicine, Ufa. Using the method of randomization envelopes in a ratio of 1:1, there were formed two groups: control (13 patients) and main (13 patients too). All participants received standard conservative treatment. The participants of the main group additionally received a course of osteopathic correction (3 sessions, an interval is 2–3 weeks, and the duration of treatment is 1–2 months). Before and after the treatment, there were assessed the pain syndrome intensity using a 10-point visual-analog scale, the motion range in the diseased joint using a goniometer, the severity of pain syndrome and limitations in the shoulder joint using the Oxford Shoulder Score questionnaire, the life quality using the SF-36 questionnaire, and the osteopathic status according to approved clinical recommendations.Results. Standard treatment of patients in the control group was accompanied by a statistically signifi cant (p&lt;0,05) decrease of the pain syndrome intensity, an increase of the motion range in the shoulder joint and a decrease of restrictions in the shoulder joint area. The inclusion of a osteopathic correction course in the treatment was accompanied by a statistically signifi cant (p&gt;&lt;0,05) more pronounced positive dynamics in all of these indicators. In addition, patients of the main group were characterized by a signifi cant (p&gt;&lt;0,05) improvement in the life quality by all indicators according to the SF-36 questionnaire. In most of the examined patients, the regional somatic dysfunctions (SD) of the thoracic region (structural and visceral components), and the dura mater region were revealed. In 100 % of patients, local SD of the shoulder joint were detected. The course of osteopathic correction was accompanied by a signifi cant (p&gt;&lt;0,05) decrease of the detection frequency of thoracic region and dura mater regional SD, and of the local SD of the shoulder joint. There was no signifi cant dynamics in the control group. Conclusion. It is recommended to include a course of osteopathic correction in the complex treatment of patients with arthrosis of the shoulder joint of I–II degrees.&gt;&lt;0,05) decrease of the pain syndrome intensity, an increase of the motion range in the shoulder joint and a decrease of restrictions in the shoulder joint area. The inclusion of a osteopathic correction course in the treatment was accompanied by a statistically signifi cant (p&lt;0,05) more pronounced positive dynamics in all of these indicators. In addition, patients of the main group were characterized by a significant (p&lt;0,05) improvement in the life quality by all indicators according to the SF-36 questionnaire. In most of the examined patients, the regional somatic dysfunctions (SD) of the thoracic region (structural and visceral components), and the dura mater region were revealed. In 100 % of patients, local SD of the shoulder joint were detected. The course of osteopathic correction was accompanied by a signifi cant (p&lt;0,05) decrease of the detection frequency of thoracic region and dura mater regional SD, and of the local SD of the shoulder joint. There was no signifi cant dynamics in the control group.Conclusion. It is recommended to include a course of osteopathic correction in the complex treatment of patients with arthrosis of the shoulder joint of I–II degrees.

CRITICAL EVALUATIONS OF INTRA-ARTICULAR PLATELET RICH PLASMA ALONE OR COMBINATION WITH MEDIAL BRANCH RADIOFREQUENCY NEUROTOMY IN PATIENTS WITH LUMBAR FACET JOINT ARTHROPATHY: A PROSPECTIVE OUTCOME STUDY

Background: Common cause of chronic low back pain is lumbar facet joint arthropathy. Radiofrequency ablation (RFA) of medial branch currently preferred treatment in facet joint pain syndrome. Platelet-rich plasma (PRP) is known to initiate mesenchymal tissue healing by concentration of several fundamental protein growth factors. Our aim in this study is to evaluate the effect of co-administration of autologous PRP in lumbar facet and RFA of the medial branch of the dorsal ramus for lumbar facet arthropathy. Methodology: This was a prospective randomised study with a blind assessor. Eighty-one consecutive patients who complained of low back pain secondary to lumbar facet joint arthropathy were randomly allocated into three-groups: Group RF: only RFA done. Group PR: received both PRP plus RFA. Group PL: received only PRP. Primary outcome of the study was assessment of pain intensity using visual analogue scale (VAS). Result: The patients who had both RFA and PRP therapy had significant decrease in VAS score as compared to its baseline in the immediate and long term follow up period ([Formula: see text] &lt; 0.001). However, for those who received only PRP, the decrease in VAS was more significant at 1 and 4 months. Similarly, there was a significant improvement in ODI score in patients who received both RFA and PRP ([Formula: see text] &lt; 0.001). There was a gradual improvement in ODI in PRP group at 4-month interval. Rescue analgesics requirement was reduced and patients were better satisfied in those who received both RFA and PRP therapy. ([Formula: see text] &lt; 0.05). Conclusion: The combined administration of RFA and PRP proved to provide better analgesia in both short-term follow up and long-term follow up than treatment with either method in patients with lumbar facet syndrome.

THE INFLUENCE OF MOBILIZATION AND ISCHEMIC COMPRESSION ON PAIN AND DISABILITY IN ADHESIVE CAPSULITIS AND MYOFASCIAL PAIN SYNDROME

The purpose of the study: to investigate the effect of end-range mobilization and ischemic compression on pain and disability scores among patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome in the thoracic region.&#x0D; Materials and methods. Goniometry of the shoulder joint, assessment of pain at the end points of the range of motion and trigger points (when applying a pressure of 2.5 kg×cm-2), as well as the Shoulder Pain and Disability Index questionnaire were used before the intervention and after physical therapy.&#x0D; Physical therapy began after an examination and consultation with an orthopedic traumatologist. The majority of patients received 15 planned procedures of end-range mobilization performed by a physical therapist within 3 weeks, only two patients received 14 and 16 procedures. Mobilization from I to V degrees of intensity according to the Maitland classification was used. The patient performed ischemic compression independently after instruction (determination of the localization of trigger points, formation of their map, training in exposure techniques). Compression was performed with an average level of pain or more than average; duration of 30 seconds for each point.&#x0D; Results. The proportion of male patients was 20.8%. In the examined group of patients, the values of Me (25%; 75%) for age were 53.5 (48.25; 58.5) years, and for the duration of symptoms 4 (2; 5.5) months. Localization of adhesive capsulitis on the right side was observed in 9 patients (37.5%), and on the dominant upper limb in 8 (33.3%) patients. In five patients, the lesion was on the dominant right limb. The evaluation of the transfer of end-range mobilization procedures at the end of the first, sixth, eleventh and last procedure established that the maximum pain on a 10-point scale during mobilization was, respectively: 10 (9; 10) points, 8 (7.25; 9) points, 7 (5 ; 8) points and 4 (3; 5) points. In the course of physical therapy, the indicators of amplitudes of movements and pain at maximum amplitude, as well as at trigger points, improved statistically. The median value for active abduction increased by 74.5° and for active flexion increased by 116.5°. The median value for active internal rotation increased by 77.5°, and for active external rotation, flexion increased by 75°. The median value of pain when reaching the maximum amplitude of active abduction decreased by 6 points, and for active flexion, internal and external rotation, the median dynamics indicator was similar. It should be noted that the pain index at the trigeminal point at the first assessment was 9 (9; 9) points, and at the final assessment it statistically improved and was 4 (3; 4) points (Z = -4.340; p&lt;0.001). All items of the Shoulder Pain and Disability Index questionnaire improved statistically, leading to improvements in domain values and the index itself. Іndicators Me (25%; 75%) of the pain domain decreased from 93 (63; 100) points to 16 (6.5; 20) points (Z = -4.287; p&lt;0.001), and the disability domain from 83.8 (56.9; 91.6) points to 5.6 (3.8; 10.9) points (Z = -4.286; p&lt;0.001). Тhe median indicator of the pain domain decreased by 77 points, and the disability domain by 78.2 points. The index decreased from 88.7 (54.1; 94.4) points to 10.5 (4.2; 15.4) points. (Z = -4.286; p&lt;0.001).&#x0D; Conclusions. The use of a combination of end-range mobilization and ischemic compression was effective in reducing the index of shoulder pain and disability among the examined patients.

Favourable mid-term outcomes following unicompartmental knee arthroplasty with wider patient selection: A single-centre experience

ObjectiveThe purpose of this study was to determine surgical outcomes of robotic-assisted UKAs utilizing a wider set of indications than traditionally utilized. Additionally, we seek to determine alternate predictive factors as potential surgical indications and contraindications. MethodsA prospectively maintained institutional joint registry was queried at a single academic centre for all patients that underwent robotic-assisted UKA between January 2010–December 2016. Surgical indication included isolated medial or lateral compartment degenerative disease with a stable knee based on physical exam. In 2013, haemoglobin A1C levels over 7.5% were considered contraindications, which was lowered to 7.0% in 2015. Preoperative alignment, age, activity level and degree of pain were not contraindications for surgery. Preoperative demographics, Oxford scores, radiographic (joint space), comorbidities and operative data were collected and reviewed to determine factors related to conversion to TKA and survivorship of the primary implant. ResultsIn total, 1878 cases were performed; however, excluding multi-joint knees, there were a total of 1186 knees in 1014 patients with a minimum 4-year follow-up. The mean age was 63.4 ​± ​10.7 years and mean follow-up was 76.4 ​± ​17.4 months. Mean BMI was 32.3 ​± ​6.5 ​kg/m2. (52.9% females, 47.1% males). There were 901 patients undergoing medial UKA, 122 patients undergoing lateral UKA and 69 patients undergoing patellofemoral UKA. In total, 85 (7.2%) knees underwent conversion to TKA. Preoperative factors such as the degree of preoperative valgus deformity (p ​= ​0.01), greater operative joint space (p ​= ​0.04), previous surgery (p ​= ​0.01), inlay implant (p ​= ​0.04) and pain syndrome (p ​= ​0.01) were associated with increased risk of revision surgery. Factors associated with decreased implant survivorship included patients with history of previous surgery (p ​< ​0.01), history of pain syndrome (p ​< ​0.01) and greater preoperative joint space (>2 ​mm) (p ​< ​0.01). There was no association of BMI to conversion to TKA. ConclusionRobotic-assisted UKA with wider patient selection demonstrated favourable outcomes at 4 years with survivorship greater than 92%. The present series agree with emerging indications that do not exclude patients based on age, BMI, or degree of deformity. However, increased operative joint space, inlay design, history of surgery and coexistence of pain syndrome are factors that increase risk of conversion to TKA. Level of evidenceLevel III.

Ефективність мобілізації та ішемічної компресії при адгезивному капсуліті та міофасціальному больовому синдромі

The purpose of the study was to investigate the effect of end- range mobilization and ischemic compression on the range of motion and pain scores in patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome in the thoracic spine. Materials and methods. 20 patients participated in the study. Goniometry of the shoulder joint, pain assessment on a numerical scale at the endpoints of the range of motion and trigger points (when applying a pressure of 2.5 kg×cm-2) were performed before the intervention, at the end of the first week of therapy, at the end of the second and third week. Physical therapy began after an examination and consultation with an orthopedic traumatologist. All patients received intensive end-range mobilization performed by a physical therapist and ischemic compression performed by the patient 5 times a week (3 weeks). Mobilization techniques from I to V degrees of intensity according to the Maitland classification system were used. Localization of active and latent trigger points was determined, their marking was carried out on an individual map, which was provided to the patient. The patient was instructed in techniques and methods of influencing trigger points of various locations. Compression was performed with an average or above average pain level and a duration of 30 seconds for each trigger point. Results and discussion. The existence of differences in the results of the amplitude was established, taking into account the time factor. The median score for active abduction increased by 65.5° and for flexion – by 115.5°. The amplitude of active internal rotation increased by 73°, and external – by 72°. According to Friedman's test, similar results were obtained when comparing pain indicators, which were assessed at the endpoints of the range of motion. The dynamics of medians was from 5 to 6 points. The median trigger point pain score decreased by 5.5 points after three weeks of physical therapy. The results obtained when studying the effectiveness of ischemic compression in patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome are consistent with the conclusions of previous studies and complement the data presented in the literature. Conclusion. Physical therapy, which consists of a combination of end-range mobilization and ischemic compression, is effective in increasing passive and active range of motion in the shoulder joint, reducing pain at the end of the range of motion, and reducing pain at trigger points

Satisfaction with the Physical Therapy in Patients with Adhesive Capsulitis and Myofascial Pain Syndrome

Aim: To investigate and compare satisfaction with the physical therapy in patients with adhesive capsulitis of the shoulder joint and concomitant thoracic myofascial pain syndrome undergoing outpatient and home programs. Materials and Methods: The study involved 76 participants. Shoulder joint mobility and pain in myofascial trigger points were assessed before and after the physical therapy program. Scale to measure patient satisfaction with physical therapy was used after the program. Patients of both groups received physical therapist consultations. The first group of patients received endrange mobilization (performed by a physical therapist) and performed ischemic compression (without any assistance). The second group of patients performed therapeutic exercises and ischemic compression without any assistance at home. The duration of the program in both groups comprised 3 weeks. Results: Mobility and pain indicators were improved in both groups. However, the results of the second assessment were better in the first group. Physical therapy satisfaction scores were high in both groups, but the first group had statistically better results in four questionnaire items and in the total score. Me (25%; 75%) indicators of the total satisfaction score comprised 85 (84.75; 85) points in the first group and 78 (77.75; 79) points in the second group. Conclusions: The patients who received consultations, end-range mobilization, and performed ischemic compression had a higher level of satisfaction as compared to the patients who attended consultations and performed therapeutic exercises and ischemic compression.

Effect of Flat Running Shoes on Hip Kinematics in Male Recreational Runners.

Patellofemoral joint pain and iliotibial band syndrome are very common running-related injuries. Excessive contralateral pelvic drop, hip adduction, and hip internal rotation have been suggested to be associated with the two injuries. The purpose of this repeated measures and the cross-sectional study was to investigate the effect of flat running shoes on these kinematic variables compared with that of conventional running shoes with a 10 mm drop. Eighteen male recreational runners were recruited to run in flat shoes and conventional shoes with a 10 mm drop, in random order. Impact force data and lower extremity kinematics were synchronously obtained using two Kistler force plates and eight motion infrared cameras, whereas differences in the impact force and hip kinematics were compared using statistical parametric mapping. Regarding hip kinematics, the hip flexion (p = 0.004) and adduction angles (p = 0.004) decreased significantly at 30-70% and 62-85% of the stance phase, respectively, while wearing flat running shoes; the contralateral pelvic drop angle (p = 0.001) decreased significantly at 31-75% of the stance phase while wearing flat running shoes. The knee internal rotation angle (p = 0.035) decreased significantly at 8-17% of the stance phase while wearing flat running shoes compared with conventional running shoes. Given that these kinematic variables are associated with patellofemoral joint pain and iliotibial band syndrome, flat running shoes may have potential benefits for the prevention or treatment of knee injuries.

Daphnoretin relieves IL-1β-mediated chondrocytes apoptosis via repressing endoplasmic reticulum stress and NLRP3 inflammasome

BackgroundOsteoarthritis (OA), mainly caused by severe joint degeneration, is often accompanied by joint pain and dysfunction syndrome. Inflammatory mediators and apoptosis play key roles in the evolution of OA. It is reported that daphnoretin has significant antiviral and anti-tumor values. The present study aims at investigating the role of daphnoretin in OA.MethodsThe OA mouse model was constructed by performing the destabilization of the medial meniscus through surgery, and the OA cell model was induced in ATDC5 chondrocytes with IL-1β (10 ng/mL) in vitro. Chondrocyte viability and apoptosis were measured by 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di-phenytetrazoliumromide (MTT), Caspase-3 activity, and flow cytometry. The levels of COX-2, iNOS, TNF-α, IL-6, Bax, Bcl2, cleaved-Caspase3, endoplasmic reticulum stress (ERS) proteins (GRP78, CHOP, ATF6, and Caspase-12), and NLRP3-ASC-Caspase1 inflammasome were determined by quantitative real-time PCR or western blot. The concentrations of TNF-α, IL-6, and PGE2 were tested by enzyme-linked immunosorbent assay. The content of nitrates was detected by the Griess method. In vivo, morphologic differences in knee joint sections and the thickness of the subchondral bone density plate in mice were observed by hematoxylin–eosin (H&E) staining and safranin O-fast green staining.ResultsDaphnoretin effectively choked IL-1β-induced chondrocyte apoptosis and facilitated cell viability. Daphnoretin dose-dependently abated ERS, inflammatory mediators, and the activation of NLRP3 inflammasomes in IL-1β-induced chondrocytes. What’s more, in vivo experiments confirmed that daphnoretin alleviated OA progression in a murine OA model by mitigating inflammation and ERS.ConclusionDaphnoretin alleviated IL-1β-induced chondrocyte apoptosis by hindering ERS and NLRP3 inflammasome.Graphical abstract

The innervation of the cervical facet joints-an anatomical and histological approach.

Cervical facet joint pain syndrome accounts for a great amount of cervical pain worldwide. This study aims to provide updated knowledge of cervical facet joint innervation with new anatomical findings. Twenty‐seven cervical facet joints and their innervating structures were dissected from five halves of three human neck specimens. Histologic staining was used to confirm that the samples were nervous tissues, and all samples were documented with photography. Histology: Thirty‐six assumed facet joint branch samples were obtained and stained. Twenty‐two of these were confirmed to be nervous tissue. Therefore, 61% of the samples were identified as facet joint branches. Of all samples, 28% were not nerves. Dissection: At least one medial branch was clearly identified at each dissected cervical level. At some cervical levels, more than one medial branch was found. Anatomical differences, such as a plexus‐like innervation in the high cervical region, were observed. Direct facet joint branches were also discovered. These branches originate directly from the dorsal root of the spinal nerve and were independent from medial branches during their direct pathway toward the facet joint. Direct cervical facet joint branches were identified and a more diverse innervation pattern than previously described of the cervical facet joints was found.

Plebeian Sage (Salvia plebeia R. Br) Extract Ameliorates Inflammation and Cartilage Degradation in Surgically Induced Osteoarthritis Rats

Osteoarthritis (OA), the most prevalent articular disease with the clinical syndrome of joint pain accompanied by varying degrees of functional limitation, reduces the quality of elderly life. In this study, the effects of Plebeian sage extract (PS) on anti-inflammatory and anti-articular cartilage degradation activities were evaluated in rats with surgically induced OA. PS supplement for 12 weeks significantly decreased Mankin scores, including inflammatory cell numbers, and improved surface cartilage damage and mean femur and tibia articular cartilage (AC) thicknesses in OA rats. PS diminished IL-1β, IL-6, TNF-α, MMP-2, MMP-3, and MMP-9, as well as lipocalin-2 levels in serum or cartilage, which were increased due to OA. The results suggested that PS decreased joint inflammation and loss of articular cartilage by suppressing provocative responses and synovial tissue decimation in the OA model. Thus, PS may be used as a novel potential therapeutic regime for OA in the elderly.

Особенности течения гипермобильного синдрома в постковидном периоде и ведение пациентов

Aim: to conduct a comparative analysis of the clinical manifestations and course patterns and needs for medical interventions in two groups of patients with joint hypermobility syndrome (JHS) (after COVID-19 and without it). Patients and Methods: two groups of patients with JHS were observed for 2 months: those who had COVID-19 (n=37) and those without COVID-19 (n=21) aged 18 to 55 years. The inclusion criterion was the absence of injuries, as well as inflammatory and acute-phase changes in blood values recorded in the ambulatory medical record. All complaints were assessed by organs and systems with the identification of the most common ones: clinical manifestations in the post-COVID period, the intensity of the musculoskeletal pain syndrome according to the visual analog scale (VAS), the levels of situational and personal anxiety degree (according to the Spielberger-Hanin test), the exclusion of depression according to the Hospital Anxiety and Depression Scale (HADS), life quality (according to the Russian version of the SF-36 v.2тм questionnaire. Results: the severity of pain in the first group of patients in the categories of "moderate and high pain" was significantly more common versus the group 2 without COVID-19. For the first time, complaints concerning vegetative-vascular dystonia of permanent (heartbeat, tachycardia, spontaneous dyspnea) and paroxysmal (panic attacks) origins were significantly more common in the group of patients who experienced COVID-19. Associations with a higher level of anxiety and a decrease in the life quality were revealed in the group 1 who experienced COVID-19. To relieve musculoskeletal pain, a group of NSAIDs was commonly prescribed in a standard therapeutic dose for 7–10 days. Incomplete pain relief, as well as two- and threefold relapses of musculoskeletal pain were noted in the group 1. The need for prescription of tofisopam anxiolytic 0.05 mg 3 times a day was due to the high and moderate levels of anxiety and permanent and paroxysmal vegetative manifestations in the group experienced COVID-19. The preservation of asthenic syndrome caused the need to prescribe a drug that regulates metabolic processes in the central nervous system: sulbutiamine 200 mg in the morning and at lunch for 4 weeks. After 1 month of treatment with tofisopam and sulbutiamine, there was a significant decrease in the anxiety level, a decrease in the intensity and relief of musculoskeletal pain, as well as an improvement in the life quality. Conclusion: the administration of adjuvant therapy in the form of an anxiolytic (tofisopam) and a drug regulating metabolic processes in the central nervous system (sulbutiamine) to the standard analgesic therapy with NSAIDs in patients who have experienced COVID-19 with severe musculoskeletal pain, vegetative and anxiety disorders leads to a significant reduction or relief of musculoskeletal pain syndromes and an improvement in the life quality. KEYWORDS: joint hypermobility syndrome, COVID-19, joint pain syndrome, post-COVID-19 period. FOR CITATION: Viktorova I.A., Ivanova D.S., Moiseeva M.V. et al. Course patterns and patient management with joint hypermobility syndrome in the post-COVID-19 period. Russian Medical Inquiry. 2022;6(3):133–139 (in Russ.). DOI: 10.32364/2587-6821-2022-6-3-133-139.