Joint Procedures Research Articles

Joint Partial Crosstalk Cancellation and Spectrum Management for xDSL Systems with Data Rate Constraints

AbstractxDSL systems have to be able to support an always increasing amount of high-rate applications. To make the applications run stably, service providers need to be capable of guaranteeing these high data rates to their customers at a limited amount of available computational complexity usable for crosstalk cancellation.In order to be able to support high data rate targets with a low amount of computational complexity, partial crosstalk cancellation was combined with spectrum management techniques. A selection procedure was found, which jointly chooses the canceled crosstalkers and the transmit powers for each user on each tone by interlacing Iterative Water Filling (IWF) and a newly developed successive crosstalk selection algorithm for partial crosstalk cancellation, which takes into account the data rate requirements of the users. It distributes the available computational complexity in an intelligent way, so that data rate requirements are fulfilled. With the joint procedure savings in computational complexity are achieved.

Inflammatory markers in temporomandibular joint disorders

Temporomandibular joint disorders (TMD) have a chronic and progressive character. Multifactor ial etiology of the disorders and difficulties in detection of first signs and symptoms caused, in many cas es, symptomatic treatment approach. The essential is to establish the sensitive and specific diagnostic methods for early causal treatment possibilities. Clinical examination and imaging techniques do not always allow the full view of the ongoing disease. The concentration of inflammation indicators, such as C – reactive protein (CRP) is not a specific tool, which does not indicate any specific disease, but the synovial fluid markers, such as cytokines and proteinases, could allow detect the early bony deteriora tion in the temporomandibular joint (TMJ), which is not visible on radiographic imaging. Although, the small amount of collected fluid from the joint and specialist laboratory procedures are not regularly obtain in daily practice. Although, early detection of tissues damaged, would enable clinicians to intro duce proper treatment and prevent irreversible degenerative changes in TMJ.

Study on FCAW Semi-Automatic Welding Procedure of Girth Weld Joint of Line Pipes

This paper investigate the mechanical property and microstructure of girth weldment of Lan Zhou to Cheng Du crude oil pipeline. The welding joint was bottomed by cellulose electrode E6010 and filled and covered by flux-cored wire AWS A 5.29 E71T8-Ni1. According to SY/T 4103-2006, test results show that the selected process parameters and welding method take on outstanding performance .Microstructure of weld joints is acicular ferrite, polygonal ferrite, proeutectoid ferrite and granular bainite, and widmanstaten ferrite dosn’t exsist in heat affected zone(HAZ). Microstrure of the whole weld joint is mainly polygonal ferrite and granular bainite, this is the reason that mechanical properties can meet the Lan Zhou to Cheng Du crude oil pipeline project requirement.

IOC consensus paper on the use of platelet-rich plasma in sports medicine : editor's choice

Acute and chronic musculoskeletal injuries in sports are common and problematic for both athletes and clinicians. A significant proportion of these injuries remain difficult to treat, and many athletes suffer from decreased performance and longstanding pain and discomfort.1 In 2008, the International Olympic Committee (IOC) published a consensus document on the importance of molecular mechanisms in connective tissue and skeletal muscle injury and healing.2 This document predicted an increase in the use of autologous growth factors, as it has indeed happened following that publication. Platelet-rich plasma (PRP) (also referred to as platelet-rich in growth factors, platelet-rich fibrin matrix, platelet-rich fibrin, fibrin sealant, platelet concentrate) is now being widely used to treat musculoskeletal injuries in sports and draws widespread media attention despite the absence of robust clinical studies to support its use.3 Of the few studies on the effectiveness of PRP in clinical settings published, very few are of sufficient methodological quality that would enable evidence-based decision-making. PRP and its variant forms were originally used in clinical practice as an adjunct to surgery to assist in the healing of various tissues. PRP has also been used in prosthetic surgery to promote tissue healing and implant integration, and to control blood loss.4 5 Furthermore, the application of activated PRP has an effect on pain and pain medication use following open subacromial decompression surgery.5 Initially, PRP was mainly used in oral surgery.6 7 Subsequently, PRP has also been used at the time of surgery involving shoulder,8 hip9 and knee joint procedures,10 11 including anterior cruciate ligament (ACL) reconstruction,12 and it has been used to improve bone healing. 13 More recently, PRP in an injectable form has been used for the management of common muscle,14 tendon15 and cartilage injuries.16 As predicted by the 2008 IOC consensus document on the molecular mechanisms in connective tissue and skeletal muscle injury and healing,2 there is significant anecdotal evidence that the use of PRP for treating musculoskeletal injuries has increased in recent times. Currently, PRP is not considered as a drug or a therapeutic substance, and so it does not have the usual regulatory requirements that would generally be needed for a substance used in regular clinical practice.

Dealing with endogeneity in a time‐varying parameter model: joint estimation and two‐step estimation procedures

Summary In dealing with the problem of endogeneity in a time-varying parameter model, we develop the joint and two-step estimation procedures based on the control function approach. We show that a key to the success of the joint estimation procedure is in an appropriate state-space representation of the model. On the other hand, a correct treatment of the problem of generated regressors plays an important role in our two-step estimation procedure. Monte Carlo experiments confirm that the estimation procedures proposed in this paper work well in finite samples. Concerning our proposed endogeneity tests, the asymptotic distribution of both the likelihood ratio and Wald tests based on the second-step regression are reasonably well approximated by a χ2 distribution even in finite samples.

An Alternative Route into the Biliary Tree Following Gastric Bypass Surgery

We present a novel case with a combined procedure of laparoscopic cholecystectomy and laparoscopic-facilitated endoscopic retrograde cholangio-pancreatography (ERCP) in a patient who had previously undergone laparoscopic Roux-en-Y gastric bypass surgery 2 years earlier. At a follow-up bariatric clinic, 2 years postobesity surgery, this 50-year-old patient complained of right upper quadrant pain and nausea. Ultrasonography and magnetic resonance cholangio-pancreatography demonstrated multiple stones within the gallbladder and in the common bile duct (CBD). A planned joint procedure with the gastroenterologists was performed. Access to the abdomen was obtained via a subumbilical port inserted under direct vision. Pneumoperitoneum was obtained and four further ports were placed. The cystic duct was identified and cannulated, and an on-table cholangiogram was performed, which confirmed the presence of multiple stones in the distal CBD. However, only one stone was amenable to extraction via a Fogarty balloon trawl. As the CBD was too narrow for choledochotomy and CBD exploration, it was decided to proceed to laparoscopic gastrostomy and transgastric ERCP. The gastrostomy was fashioned in the remnant stomach and secured with a purse string suture. A 15-mm port was then inserted into the left upper quadrant and a side-viewing endoscope was introduced through this port into the gastrostomy. The duodenal papilla was identified and cannulated, and a cholangiogram reconfirmed stones in the CBD. A sphincterotomy was performed, followed by a balloon trawl and extraction of the gallstones. Completion cholangiogram demonstrated a clear biliary tree. Single layer closure of the gastrostomy and laparoscopic cholecystectomy was then undertaken. This patient made an uneventful recovery and was discharged home 2 days postprocedure. We suggest that this is a useful technique for the retrieval of stones in the biliary tree in patients who have had previous Roux-en-Y gastric bypass surgery. No competing financial interests exist. Runtime of video: 6 mins 52 secs

Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part II–prognostic factors for clinical and radiographic outcomes

A rotator cuff registry was established to prospectively evaluate the effectiveness of all-arthroscopic repairs. The purpose of this study is to report prognostic factors for successful clinical and radiographic outcomes at 5 years. One-hundred ninety-three patients underwent all-arthroscopic rotator cuff repairs. Pre- and intraoperative data were compared to the American Shoulder and Elbow Surgeon (ASES) score, range of motion, muscle strength, and ultrasound results at 5 years using univariate, and multivariate analyses. At 5 years, 106 patients completed follow-up. There were no pre- or intraoperative variables that were predictive of an ASES score >90. Factors predictive of a radiographic defect were larger size of the lesion (OR 1.72, 95% CI 1.04-2.85, P = .03), multiple tendon involvement (OR 5.56, 95% CI 1.23-25.22, P= .02), older age (OR 1.15, 95% CI 1.04-1.28, P = .01), concomitant biceps (OR 16.16, 95% CI 3.01-86.65, P = .001), and acromioclavicular joint procedures (OR 6.70, 95% CI 1.46-30.73, P = .01). Radiographic healing did not correspond to clinical outcomes. Resolution of a radiographic defect was seen in 14 patients. Younger age (OR 0.84, 95% CI 0.74-0.95, P = .004) and single-tendon tears (OR 7.59, 95% CI 1.71-84.45, P = .04) were predictive. Larger tears in older patients who undergo concomitant procedures are predictive of radiographic defects at 5 years; however, radiographic healing did not correspond to clinical results. Younger patients with single tendon tears are more likely to undergo spontaneous resolution of a radiographic defect. This information can be useful in counseling patients regarding the mid-term results of this procedure.

Solving the Puzzle of Bolted Joints

This article discusses the various ways of solving the puzzle of bolted joint assembly. In 2001, The PCC-1-2000 Guidelines for Pressure Boundary Bolted Flange Joint Assembly presented with knowledge and practices specific to the assembly of bolted flange joints. The puzzle solution that came from this box was the most definitive to date and allowed those dealing with bolted joints to assemble the variables by methods that had been used successfully for many years by many people. This document is helping people across industry not only to assemble bolted flange joints, but also to establish joint integrity programs, procedures, and best practices. PCC-1-2010 shifts the emphasis to gasket stress and gasket type and provides instruction and information pertinent to bolt torque values. The 2010 document contains, for instance, a whole section on bolt stress—the unit load that should be put on the bolts—and includes tables as well.

Treatment of Hyperextension Deformity of the Thumb Metacarpophalangeal Joint in Basal Joint Arthritis

Advanced stages of basal joint arthritis are sometimes characterized by an adduction deformity of the first metacarpal and a hyperextension deformity of the unstable metacarpophalangeal (MCP) joint. Stabilizing the MCP joint in these patients is critical to ensure a pain-free repair and efficient pinch mechanism. This study presents the anatomic basis for a novel capsulodesis technique using the volar plate that can be incorporated into any reconstructive basal joint procedure when clinically indicated. Eleven normal cadavers were dissected to expose the volar plate. The dimensions of the volar plate, relationship of the sesamoid bones to the oblique pulley, and the distance from the sesamoids to the base of the proximal phalanx were compared between specimens. The radial border of the volar plate measured 8.5 ± 1.3 mm, ulnar border 8.8 ± 1.0 mm, proximal border 7.5 ± 1.0 mm, and distal border 7.8 ± 0.6 mm. The distance between the ulnar sesamoid bone and the oblique pulley measured 12.1 ± 1.1 mm and from the radial sesamoid to the oblique pulley measured 16.6 ± 0.2 mm. The distance between the sesamoids and the base of the phalanx measured 2.2 ± 0.2 mm. The anatomic studies provide a foundation on which the surgeon can understand the complex nature of the MCP joint. This study describes a novel technique for MCP capsulodesis of the thumb in which volar plate flaps are imbricated to provide stability to the MCP joint, obviating the need for suture anchors and tendon grafts.

Relationship between the Effectiveness of Arthrocentesis under Sufficient Pressure and Conditions of the Temporomandibular Joint

Background. The purpose of this study is to investigate the conditions of the temporomandibular joint relative to the effectiveness of an arthrocentesis-like enforced manipulation technique followed by irrigation under high pressure in patients with closed lock. Methods. We performed arthroscopic examination and manipulation followed by irrigation as the initial treatment in 50 joints with closed lock. Relationship between the effectiveness of the procedure and conditions of the temporomandibular joint was statistically analyzed using multiple regression analysis. Results. Significant inverse correlations were found between the extent of improvement in maximum mouth opening after treatment and the initial maximum opening before treatment. There were no significant correlations between improvement of joint pain at mouth opening and in biting and conditions of the temporomandibular joint. Conclusions. Pathologic conditions of the temporomandibular joint did not have an influence on the efficacy of the technique. This result suggests that this procedure has wider application than conventional arthrocentesis.

The challenges in predicting the fatigue life of dissimilar brazed joints and initial finite element results for a tungsten to EUROFER97 steel brazed joint

This paper summarises the challenges in accurately predicting stress states in dissimilar brazed joints and presents initial results from a finite element analysis of a tungsten to EUROFER97 brazed joint. The residual stresses due to joint manufacture are presented and differences in stress distribution due to thermal and mechanical loading highlighted. The results from this analysis correlate well to experimental results from previous research however further validation is required. The challenges in developing fatigue assessment procedures for dissimilar brazed joints are also discussed. These fatigue assessment procedures are introduced and a validation strategy for such procedures is proposed.

Prominencia esternoclavicular: hiperostosis u osificación interarticular ¿Un cajón de sastre?

Introduction In clinical practice, we see quite often painful sterno-clavicular prominence, deformity, which is the hallmark of two entities with a low incidence, although well defined hyperostosis cost sterno-clavicular (HECC) and ossification cost inter-sterno-clavicular (OIECC). The differential diagnosis of these conditions, you must include sterno-clavicular arthritis, Paget's disease, condensing osteitis, osteomyelitis, pustulosis, Friederich's disease, Tietze's syndrome and osteoid osteoma. This is especially important in cases where the involvement is unilateral. Material and methods We present a series of nine patients complaining of a painful sterno- clavicular prominence, compatible with HECC or OIECC. The reason for consultation in most patients was rule out the presence of a tumor in that location. Results Image studies showed a variable increase both the density and bone mass as well as different intensities of joint involvement sterno-clavicular cost. Conclusion Ruled out a tumor and a specific diagnosis of these, you do not need aggressive treatment, is generally considered sufficient anti-inflammatory treatment in most patients. In clinical practice, it is irrelevant and OIECC HECC differentiation, since treatment and prognosis of both conditions are similar. The biopsy of the joint and aggressive diagnostic procedures may be unnecessary.

In-hospital rehabilitation after multiple joint procedures of the lower extremities in haemophilia patients: clinical guidelines for physical therapists

This project aimed to develop guidelines for use during in-hospital rehabilitation after combinations of multiple joint procedures (MJP) of the lower extremities in persons with haemophilia (PWH). MJP are defined as surgical procedures on the ankles, knees and hips, performed in any combination, staged, or during a single session. MJP that we studied included total knee arthroplasty, total hip arthroplasty and ankle arthrodesis. Literature on rheumatoid arthritis demonstrated promising functional results, fewer hospitalization days and days lost from work. However, the complication rate is higher and rehabilitation needs optimal conditions. Since 1995, at the Van Creveldkliniek, 54 PWH have undergone MJP. During the rehabilitation in our hospital performed by experienced physical therapists, regular guidelines seemed useless. Guidelines will guarantee an optimal physical recovery and maximum benefit from this enormous investment. This will lead to an optimal functional capability and optimal quality of life for this elderly group of PWH. There are no existing guidelines for MJP, in haemophilia, revealed through a review of the literature. Therefore, a working group was formed to develop and implement such guidelines and the procedure is explained. The total group of PWH who underwent MJP is described, subdivided into combinations of joints. For these subgroups, the number of days in hospital, complications and profile at discharge, as well as a guideline on the clinical rehabilitation, are given. It contains a general part and a part for each specific subgroup.

Sterno-clavicular prominence: hyperostosis or interarticular ossifiction. It is a ragbag?

Introduction In clinical practice, we see quite often painful sterno-clavicular prominence, deformity, which is the hallmark of two entities with a low incidence, although well defined hyperostosis cost sterno-clavicular (HECC) and ossification cost inter-sternoclavicular (OIECC). The differential diagnosis of these conditions, you must include sterno-clavicular arthritis, Paget's disease, condensing osteitis, osteomyelitis, pustulosis, Friederich's disease, Tietze's syndrome and osteoid osteoma. This is especially important in cases where the involvement is unilateral. Material and methods We present a series of nine patients complaining of a painful sterno- clavicular prominence, compatible with HECC or OIECC. The reason for consultation in most patients was rule out the presence of a tumor in that location. Results Image studies showed a variable increase both the density and bone mass as well as different intensities of joint involvement sterno-clavicular cost. Conclusion Ruled out a tumor and a specific diagnosis of these, you do not need aggressive treatment, is generally considered sufficient anti-inflammatory treatment in most patients. In clinical practice, it is irrelevant and OIECC HECC differentiation, since treatment and prognosis of both conditions are similar. The biopsy of the joint and aggressive diagnostic procedures may be unnecessary.

Transfusion and Inpatient Outcomes In Elective Total Hip Replacement (THR) or Total Knee Replacement (TKR) Surgery Among Adults

AbstractAbstract 4761 Introduction:THR/TKR surgery can be accompanied by high blood loss and need for transfusion in the perioperative period. This claims-based analysis describes the use of blood transfusion and selected clinical and economic outcomes in elective THR/TKR surgery patients <65 years of age. Methods:Patients aged 18 to 64 years with a THR/TKR surgery claim (index) between 1/1/06 and 12/31/08 were identified in the Thomson Reuters MarketScan® Commercial and Medicare Supplemental Databases. Eligible patients had continuous health plan enrollment for ≥6 months before the index surgery admission and ≥6 months following surgery discharge. Patients were excluded if their surgery was associated with multiple joint procedures, revision surgery, or trauma diagnosis. Patients with a claim for myelosdysplastic syndrome, chronic kidney disease, renal dialysis, human immunodeficiency virus infection, cancer, chemotherapy, sickle cell anemia, or a hospitalization or emergency room visit 6 months before surgery were excluded. Patients were categorized into 2 groups based on transfusion status during index surgery stay. The transfused (T) group had a blood transfusion claim while the non-transfused (NT) did not. The outcomes evaluated included the proportion of patients with an infection claim (wound site infection, pneumonia, urinary tract infection, Clostridium difficile, septicemia, or other), transfusion, transfusion reaction (TR), length of stay (LOS), intensive care unit (ICU) stay, discharge destination, and inpatient costs. Descriptive statistics were used to assess mean, median, and standard deviation (SD). Differences between T and NT groups were assessed by chi-square or two-sample t-tests. Results:A total of 64,014 patients met the study criteria. Mean age of the population was 56.1 ± 6.1 years, 57% were female, and 99% were insured. The mean LOS was 4.3 days. Median inpatient cost was US$24,027. During THR/TKR admission, 3.4% of patients had an ICU stay and 2.4% had an infection claim. The majority of patients (82%) were discharged home (45.9% with self-care; 35.8% required home health services), 10% were transferred to another facility, and 8% had unknown or other destinations. A transfusion claim was found in 8.3% of patients (n=5,302), and of these, 0.2% (n=11) had a TR claim. As reported in the table below, comparisons of outcomes between T and NT groups revealed differences in LOS, proportion of patients with an infection, proportion of patients with an ICU stay, and discharge destination. Median inpatient costs were $26,906 and $23,780 for T and NT groups, respectively.OutcomeOverallT GroupNT Groupp-value (T vs NT group)n64,0145,30258,712LOS, days, mean ± SD4.3 ± 1.64.5 ± 1.84.2 ± 1.6<0.001Patients with infection, %2.4%4.1%2.2%<0.001Patients with ICU stay, %3.4%4.6%3.3%<0.001Discharge destination, % patients<0.001Home with home health services35.8%47.1%34.8%Home with self-care45.9%36.4%46.8%Transfer10.0%14.1%9.6%Unknown/Other8.3%2.4%8.8% Conclusion:This retrospective claims-based analysis describes outcome parameters associated with inpatient THR/TKR surgery patients <65 years of age. The group with a transfusion claim was observed to have longer LOS, a higher proportion of patients with documented infection, ICU stay, post-surgery supportive care, and higher cost as compared to patients without a transfusion claim. Additional research to substantiate these findings in the overall THR/TKR population is warranted. Disclosures:Ellis:Centocor Ortho Biotech Services, LLC: Employment. Bailey:Centocor Ortho Biotech Services, LLC: Employment. Forlenza:Centocor Ortho Biotech Services, LLC: Employment. Senbetta:Centocor Ortho Biotech Services, LLC: Employment. Landsman-Blumberg:Centocor Ortho Biotech Services, LLC: Consultancy, Research Funding.

Transfusion and Post-Hospital Discharge Outcomes In Elective Total Hip Replacement (THR) or Total Knee Replacement (TKR) Surgery Among Adults

AbstractAbstract 3814 Introduction:This retrospective claims analysis describes transfusion use and outcomes following discharge from elective THR/TKR surgery in patients <65 years of age. Methods:Patients aged 18 to 64 years with a THR/TKR surgery claim (index) between 1/1/06 and 12/31/08 were identified in the Thomson Reuters MarketScan® Commercial and Medicare Supplemental Databases. Eligible patients had continuous health plan enrollment for ≥6 months before the surgery admission and ≥6 months following surgery discharge. Patients were excluded if their surgery was associated with multiple joint procedures, revision surgery, or trauma diagnosis. Inpatient joint revision surgeries were excluded from readmission analyses. Patients with a claim for myelosdysplastic syndrome, chronic kidney disease, renal dialysis, human immunodeficiency virus infection, cancer, chemotherapy, sickle cell anemia, or a hospitalization or emergency room visit 6 months before surgery were excluded. Patients were categorized into 2 groups based on transfusion status during index surgery stay. The transfused (T) group had a blood transfusion claim while the non-transfused (NT) did not. Outcomes evaluated included the proportion of patients with an infection claim (wound site infection, pneumonia, urinary tract infection, Clostridium difficile, septicemia, or other) within 30 days of discharge, proportion of patients readmitted within 180 days of discharge, time to first readmission, readmission length of stay (rLOS), and readmission cost. Descriptive statistics included mean, median, and standard deviation (SD). Differences between the T and NT groups were assessed by chi-square or two-sample t-tests. Results:A total of 64,014 patients met the inclusion criteria. Mean age of the population was 56.1 ± 6.1 years, 57% were female, and 99% were insured. A transfusion claim was found for 8.3% of patients during index admission. Within 180 days after surgery discharge, 12.6% of patients were readmitted; mean time to first readmission was 79 days. Approximately 57% of first readmissions occurred ≤ 90 days after discharge while 43% occurred 90 to 180 days after discharge. The average rLOS for all readmissions was 5.3 days and median cost was $18,917. A claim for infection within 30 days of THR/TKR discharge was noted for 1.9% of patients. As reported in the table below, 2.6% in the T group had a claim for infection within 30 days of discharge versus 1.9% in the NT group (p<0.001). The proportion of patients readmitted after THR/TKR discharge was similar for T and NT groups, as was the rLOS (p=NS for both). On average, readmission occurred about 5 days earlier in the T versus NT group (p<0.001). Median readmission costs were $19,816 in the T group and $18,877 in the NT group. Conclusions:The proportion of THR/TKR patients with a readmission and rLOS did not differ between T and NT groups in this claims-based analysis. However, this study observed a higher proportion of patients with a transfusion claim during THR/TKR surgery having an infection within 30 days after surgery, a shorter time to readmission and higher readmission costs as compared to patients without a transfusion claim. Further research is needed to confirm these observations in other data sources. Disclosures:Ellis:Centocor Ortho Biotech Services, LLC: Employment. Bailey:Centocor Ortho Biotech Services, LLC: Employment. Forlenza:Centocor Ortho Biotech Services, LLC: Employment. Senbetta:Centocor Ortho Biotech Services, LLC: Employment. Landsman-Blumberg:Centocor Ortho Biotech Services, LLC: Consultancy, Research Funding.

Temporomandibular joint disc repositioning using bone anchors: an immediate post surgical evaluation by Magnetic Resonance Imaging

BackgroundOpen joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs.MethodsConsecutive 81 patients with unilateral TMJ internal derangement (ID) (81 TMJs) were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique.ResultsPostoperative MRIs (one to seven days) confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints). Only 3.7% (3 of 81) of the joints were designated as poor results requiring a second open surgery.ConclusionsThis procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.

The use of spinal and sacroiliac joint procedures within the British osteopathic profession. Part 1: Assessment

Background & objectives A wide range of procedures for the assessment of spinal and pelvic disorders has been described in the osteopathic literature, but little is known concerning the methods used by osteopaths in the United Kingdom (UK). This study examined the perception of usefulness and reported use of physical assessment procedures by UK osteopaths. Part 2 of this study will examine the commonly reported treatment methods. Methods A web-based questionnaire using a 5-point Likert scale and open-ended responses was developed and invitations were e-mailed to all registrants of the General Osteopathic Council in the UK with a listed e-mail address (approximately 2700). The available response categories (strongly disagree, disagree, etc.) were converted into numerically weighted scales. Responses in the “agree” and “strongly agree” categories and the “frequently” and “nearly always” categories were combined for summary reporting purposes. Friedman tests were used to determine if significant differences existed for the reported usage of each item. The effect of gender was analysed using Mann–Whitney tests. The effect of years of practice was examined by categorizing practice experience by decade (0–9, 10–19, 20+) and analysing using Kruskal–Wallis tests. Results 520 Osteopaths (56% male, 44% female) with a wide range of years of practice experience (0–36 years, mean 11.6 years, SD 9.7) participated in the survey. The majority of respondents (81%) agreed that the identification of dysfunction to the joints and tissues of the spine were important to their practice, but there was spread of opinion regarding the importance of identifying spinal dysfunctions affecting a single vertebral level. Respondents reported that paraspinal tissue texture changes (93%), range of joint motion (93%), and quality of joint motion (91%) were the most relevant and important clinical findings for the identification of segmental spinal dysfunction and that asymmetries of spinous or transverse processes were the least important of the offered choices ( p < 0.001). Respondents deemed provocation of sacroiliac joint pain (82%), reduced range of sacroiliac motion (79%), and tenderness around the sacroiliac joint (80%) as the most highly relevant and important clinical findings for the identification of pelvic and sacroiliac somatic dysfunction ( p < 0.001). Significant differences were found for the effect of years of experience and gender for many of these procedures. Conclusion Osteopathic practitioners in the UK who responded to this survey agreed that the identification of segmental disturbances to the joints and tissues of the spine were important to their practice. Clinical findings considered to be important for the identification of spinal and sacroiliac joint dysfunction have been reported.

The use of spinal and sacroiliac joint procedures within the British osteopathic profession. Part 2: Treatment

Background and Objectives Little is known concerning the preferences for technique selection by osteopaths in the United Kingdom (UK) for the treatment of spinal, pelvic and sacroiliac dysfunction or for the methods of documentation of dysfunction in case records. Part 1 described the perception of usefulness and reported use of physical assessment procedures. This second part surveys the treatment methods reported to be commonly used by UK osteopaths. Methods A web-based questionnaire using a 5-point Likert scale and open-ended responses was developed. Invitations were e-mailed to all registrants of the General Osteopathic Council in the UK with a listed e-mail address. The available response categories (strongly disagree, disagree, etc.) were converted into numerically weighted scales. Responses in the “frequently” and “nearly always” categories were combined for summary reporting purposes. Friedman tests were used to determine if significant differences existed for the reported usage of each item. The effect of gender was analysed using Mann–Whitney tests. The effect of years of practice was examined by categorizing practice experience by decade (0–9, 10–19, 20+) and analysing using Kruskal–Wallis tests. Results 520 Osteopaths (56% male, 44% female) participated in the survey, which was a 19% response rate. Procedures for the treatment of dysfunction of the spine reported to be most commonly used were passive joint articulation (91%) and soft tissue technique (91%), followed by prescription of patient self-stretches (76%) and high velocity low amplitude thrust (HVLA, 74%, p < 0.001). Females reported more frequent use of a number of procedures, but male respondents reported more frequent use of HVLA ( p < 0.012). Respondents with 20 or more years experience reported use of a number of techniques less frequently than less experienced respondents. Preferences for the treatment of pelvic and sacroiliac dysfunction mirrored those for the spine. The majority of respondents document the physical findings associated with spinal dysfunction and note the specifics of dysfunction using motion restriction terminology. Conclusion Survey respondent osteopaths in the UK use a large range of manual treatment techniques, with a preference for direct techniques, such as passive joint articulation, soft tissue technique, and HVLA. Females reported more frequent use of a number of procedures, which may represent a reporting bias, but male respondents reported more frequent use of HVLA.

US-guided interventional joint procedures in patients with rheumatic diseases—When and how we do it?

Objective To describe the main indications and the technical steps to perform ultrasound guided procedures in patients with rheumatic diseases. To access procedures accuracy, safety and effectiveness. Materials and methods 27 patients with pain related to articular complications of rheumatic diseases and according to previous radiographic or US exam were submitted to several US-guided procedures. 42% of patients ( n = 11) had rheumatoid arthritis, 11% ( n = 3) spondyloarthropathies, 18% ( n = 5) psoriatic arthritis, 15% ( n = 4) undifferentiated arthritis, 3% ( n = 1) Sjögren syndrome and 11% ( n = 3) had gout. Described procedures are synovial biopsies, intra-articular injections of corticosteroids, radiation synovectomy and synovial cysts drainage procedures. When a therapeutical procedure was made, patients were evaluated by 2 rheumatologists. Corticosteroids used were Prednisolone and Triamcinolone. Yttrium-90 was used for synovectomy. Results In all cases success was achieved with correct needle placement inside the joint. After injection/aspiration symptoms successfully solved with all patients improving their health status. No complications were recorded during follow-up period. Conclusions US-guidance is very reliable to afford a safety procedure always checking the injection, biopsy or aspiration. Guided-biopsy has high success rates obtaining several samples. Thus is also possible to use more powerful/long acting therapeutic drugs aggressive to extra-articular structures avoiding complications.