Joint Range Of Motion Limitation Research Articles

What is the effectiveness of the combination of massage therapy and heat therapy on joint range of motion? Experimental study in patients with shoulder pain

This study aims to evaluate the effectiveness of a combination of massage therapy and heat therapy on improving joint range of motion in patients with shoulder pain. Shoulder pain is often accompanied by limited range of motion, which can affect daily activities and quality of life. Massage therapy is known to relieve muscle tension and improve blood circulation, while heat therapy has the effect of reducing muscle stiffness and increasing tissue elasticity. The combination of these two therapies is expected to provide synergistic benefits in overcoming shoulder pain problems and improving joint range of motion. This research method is pre-experimental with a one group pretest and posttest design approach. The study involved giving a combination of masage therapy and heat therapy regularly to a group of patients with shoulder pain. Joint range of motion was evaluated before and after the intervention using a pretest-posttest design. Statistical analysis, including t-test and significance test, was used to assess the difference between the mean pretest and posttest. The results showed a significant increase in the mean posttest compared to the pretest. The results of the significance test also showed that the effect that occurred was significant (0.001 <0.05), indicating the effectiveness of the combination of massage therapy and heat therapy in increasing joint range of motion in patients with shoulder pain.These findings provide strong support for the implementation of a combination of massage therapy and heat therapy as an effective approach in shoulder pain rehabilitation by improving joint range of motion limitations. This study contributes to the scientific understanding of the synergistic benefits of both therapies and provides a basis for the development of improved treatment guidelines for individuals with similar conditions. Keywords: Massage therapy, heat therapy, joint range of motion, shoulder pain.

Randomized placebo-controlled double-blind phase II study of zaltoprofen for patients with diffuse-type and unresectable localized tenosynovial giant cell tumors: The REALIZE study.

BackgroundA tenosynovial giant cell tumor (TGCT) is a locally aggressive benign neoplasm arising from intra- or extra-articular tissue, categorized as localized (L-TGCT, solitary lesion) and diffuse (D-TGCT, multiple lesions) TGCT. Surgical excision is the mainstay of the treatment, and a high local recurrence rate of approximately 50% has been reported. We focused on zaltoprofen, a nonsteroidal anti-inflammatory drug that can activate peroxisome proliferator-activated receptor gamma (PPARγ) and inhibit the proliferation of TGCT stromal cells. Therefore, we conducted a randomized trial to evaluate the safety and effectiveness of zaltoprofen in patients with D-TGCTs or unresectable L-TGCTs.MethodsThis randomized, placebo-controlled, double-blind, multicenter trial evaluated the safety and efficacy of zaltoprofen. In the treatment group, zaltoprofen (480 mg/day) was administered for 48 weeks; the placebo group received similar dosages without zaltoprofen. The primary outcome was progression-free rate (PFR) 48 weeks after treatment administration. Disease progression was defined as the following conditions requiring surgical intervention: 1) repetitive joint swelling due to hemorrhage, 2) joint range of motion limitation, 3) invasion of the adjacent cartilage or bone, 4) severe joint space narrowing, and 5) increased tumor size (target lesion).ResultsForty-one patients were allocated to the zaltoprofen (n=21) or placebo (n=20) groups. The PFR was not significant between the zaltoprofen group and the placebo group at 48 weeks (84.0% and 90.0%, respectively; p=0.619). The mean Japanese Orthopedic Association knee score significantly improved from baseline to week 48 in the zaltoprofen group (85.38 versus 93.75, p=0.027). There was a significant difference between the values at 48 weeks of placebo and zaltoprofen group (p=0.014). One severe adverse event (grade 3 hypertension) was observed in the zaltoprofen group.DiscussionThis is the first study to evaluate the efficacy and safety of zaltoprofen in patients with TGCT. No significant differences in PFR were observed between the groups at 48 weeks. Physical function significantly improved after zaltoprofen treatment. The safety profile of zaltoprofen was acceptable. This less invasive and safer treatment with zaltoprofen, compared to surgical removal, could be justified as a novel approach to treating TGCT. Further analysis of long-term administration of zaltoprofen should be considered in future studies.Clinical Trial RegistrationUniversity Hospital Medical Information Network Clinical Trials Registry, identifier (UMIN000025901).

Neuromuscular Consequences of Lumbopelvic Dysfunction: Research and Clinical Perspectives.

Injuries involving the lumbopelvic region (ie,lumbar spine, pelvis, hip) are common across the lifespan and include pathologies such as low back pain, femoroacetabular impingement syndrome, labrum tear, and osteoarthritis. Joint injury is known to result in an arthrogenic muscle response which contributes to muscle weakness and altered movement patterns. The purpose of this manuscript is to summarize the arthrogenic muscle response that occurs across lumbopelvic region pathologies, identify methods to quantify muscle function, and propose suggestions for future research. While each lumbopelvic region pathology is unique, there are a few common impairments and a relative consistent arthrogenic muscle response that occurs across the region. Hip muscle weakness and hip joint range of motion limitations occur with both lumbar spine and hip pathologies, and individuals with low back pain are known to demonstrate inhibition of the transversus abdominis and multifidus. Assessment of muscle inhibition is often limited to research laboratory settings, but dynamometers, ultrasound imaging, and electromyography offer clinical capacity to quantify muscle function and inform treatment pathways. Future studies should systematically determine the arthrogenic muscle response across multiple muscle groups and the timeline for changes in muscle function and determine whether disinhibitory modalities improve functional outcomes beyond traditional treatment approaches.

Study on the Effect of Muscle Compression on Joint Range of Motion Limitation in Rats.

Study on the Effect of Muscle Compression on Joint Range of Motion Limitation in Rats.

Development of a passive exercise device to turn the forearm pronation and supination using pneumatic soft actuators

The symptoms of joint range of motion limitation make life difficult and aggravate quality of life. Usually, physical therapists provide rehabilitation training to prevent it. In this study, we have developed a passive motion device for pronation and supination of the forearm. This paper describes the prototype and the evaluation test of the device. We used a pneumatic soft actuator that can press directly on the affected area to develop the device. The pneumatic soft actuator consists of aluminum laminate films and an air supply tube. The device performs these motions for the forearm by the actuator directly pushing the wrist. In the evaluation test, the force generated by the pneumatic soft actuator was measured and we had a questionnaire about performance of the device from 10 subjects. The all subjects were able to perform passive movements of internal and external rotation of the arms. The tests also revealed that the device could allow the subjects to move otherwise from 60% to 80% of their reference range of motion.

Effectiveness of rehabilitation on pain and function in people affected by hemophilia.

Introduction:Literature provides unclear evidence of the effectiveness of many physiotherapy interventions on pain intensity, quality of life, and functional ability in hemophilic patients, and suggests that rehabilitation programs should be focused on functional goals and the disability of patients.Aim:The aim of the present study is to present the outcome of a case series of patients with hemophilia in which a rehabilitation program has been carried out on the basis of a specific individual patient's functional impairment.Methods:Fifty-one patients were enrolled: 32 patients (Rehab Group) received a rehabilitative treatment, 19 patients for different reasons (living far from the hospital, family problems) did not receive rehabilitation (Control Group). The rehabilitation program was planned with respect to the emergent problems: musculoskeletal pain, joint range of motion limitation, muscle flexibility, walking difficulties, the appearance of hematomas/hemartro, and postural problems. All the patients were assessed at baseline (T0), after 1 month (T1), and after 3 months (T2) through visual analogic scale for musculoskeletal pain, the Hemophilia Joint Health Score for joint range of motion, the Functional Independence Score in Hemophilia for disability, and postural assessment by visual inspection.Results:A significant reduction of pain and improvement of Hemophilia Joint Health Score and Functional Independence Score in Hemophilia score was found in the Rehab Group along with the follow-up. Pain in the Control Group was lower with respect to the other group at baseline and significantly decreased after 1 month.Conclusion:A rehabilitation program focused on individual impairment of patients with hemophylia determined satisfying results in terms of pain control, functional, and disability improvement in 3 months follow-up.

The degree of joint range of motion limitations after burn injuries during recovery

IntroductionThe aim of this study was to determine the degree of ROM limitations of extremities, joints and planes of motion after burns and its prevalence over time. MethodThe database of a longitudinal multicenter cohort study in the Netherlands (2011–2012) was used. From patients with acute burns involving the neck, shoulder, elbow, wrist, hip, knee and ankle joints that had surgery, ROM of 17 planes of motion was assessed by goniometry at 3, 6 weeks, 3–6–9 and 12 months after burns and at discharge. ResultsAt 12 months after injury, 12 out of 17 planes of motion demonstrated persistent joint limitations. The five unlimited planes of motion were all of the lower extremity. The most severely limited joints at 12 months were the neck, ankle, wrist and shoulder. The lower extremity was more severely limited in the early phase of recovery whereas at 12 months the upper extremity was more severely limited. ConclusionThe degree of ROM limitations and prevalence varied over time between extremities, joints and planes of motion. This study showed which joints and planes of motion should be watched specifically concerning the development of scar contracture.

Healthcare Utilization and Health Related Quality of Life in Persons with Von Willebrand Disease

Healthcare Utilization and Health Related Quality of Life in Persons with Von Willebrand Disease

Is Hemophilia B Clinically Less Severe Than Hemophilia a? Evidence from the Hugs Va and Vb Studies

Introduction Emerging research suggests key differences in clinical manifestations among people with hemophilia A (HA) and hemophilia B (HB) that may impact health-related quality of life (HRQoL), healthcare utilization and costs. However, HB's low prevalence hinders obtaining study cohorts large enough to be representative and avoid selection bias. This analysis of the Hematology Utilization Group Studies (HUGS) cohorts examined over a 2-year period (1) baseline pain, joint range of motion (ROM), and HRQoL (2) clinical characteristics and treatment outcomes, and (3) costs of care and service utilization among a geographically diverse sample of individuals with HB and HA. Materials and Methods HUGS part Va (enrolling HA) and HUGS part Vb (enrolling HB) are US multicenter observational studies conducted at hemophilia treatment centers (HTCs) serving patients from 15 states. HUGS Va was conducted 2005-2007; HUGS Vb 2009-2014. This analysis included 350 participants with complete medical records and ≥2 follow-up surveys: 243 with HA and 107 with HB. Children (age 2-17 years) and adults (age 18-64 years) were followed prospectively. Mean ages at baseline were 21.3 (HA) and 24.5 (HB); 70% of HA participants were severely affected, as were 46% with HB. HUGS collected data through an initial, in-person interview with participants or parents after informed consent; regularly scheduled web-, mail-, or phone-based follow-up questionnaires; and clinical chart review conducted by HTC staff. Treatment utilization and costs were annualized including direct and indirect costs. Medication cost was obtained from payment allowance limits for Medicare Part B. Costs were adjusted for inflation to reflect costs in 2019. We compared continuous variables using Wilcoxon-Mann-Whitney and Chi-square or Fisher's exact test for categorical variables. Results Quality of Life and Clinical Measures Both severe adults HA (mean±SD: 40.7±10.4) and HB (42.6±11.4) showed lower SF-12 physical composite score than the general US population (50±10). Severe HB children had mean 6 points greater physical health summary score than severe HA children. Pain and joint ROM limitation were reported less often by those with severe HB (63% and 58%, respectively), compared to those with severe HA (81% and 77% respectively). Among HB children with severe hemophilia, 12% reported pain compared to 28% with HA. Joint ROM limitation was reported in 8% of HB children, compared to 16% with HA. HB children having half the burden than HA on reported pain and joint ROM limitation. Median annualized missed work days were significant lower in the HB group (3) than HA (7), P<0.01. Adults with severe HB missed a median 4 days of work annually, compared to 7 days for those with severe HA (P=0.04). At baseline, the pediatric severe HB group had overweight/obesity double the HA group (P=0.03), but nearly 50% of both adult severe populations were overweight/obese. Treatment and Outcomes At baseline, adults with severe HB were slightly more likely to use prophylaxis than HA adults (50% versus 43%). HA children, however, were more likely than HB children (84% versus 64%) to treat prophylactically (P=0.03). Mild/moderate HA and HB cohorts rarely used prophylaxis. At follow-up, both severe and mild/moderate HA adults experienced significantly greater annualized bleeding rates than adults (P<0.01). Cost and Service Utilization The follow-up data indicated that the median number of ED visits among both severe HA and HB adults was 0, but the means were 0.1 and 0.5 respectively (P=0.04), and range was lower among the HB group (0-1) than in HA (0-8). Among adults, median annual total costs for severe HB ($135,299) were significantly lower than for severe HA ($317,961), P<0.001. Among children, median annual total costs among those with severe HB ($164,681) were lower than for those with severe HA ($236,537), P=0.04. Conclusions At baseline, the HUGS Va and Vb cohorts revealed less clinical burden among those with HB than those with HA, indicating that people with HB may experience fewer symptoms and effects from the disease. The fact that the HB cohort had lower costs and healthcare utilization over a 2-year period supports this finding. Overweight/obesity exceeded 2/3 for adults with mild/moderate HA and HB. Despite the relatively small HB sample size, analyses of HUGS cohort studies provide valuable information about people treated at HTCs in the US. Disclosures Curtis: Wyeth, now Pfizer: Consultancy; Bayer Foundation: Consultancy; CSL Behring: Consultancy; Baxalta, now part of Takeda: Consultancy; Novo Nordisk: Consultancy. Lou:Wyeth, now Pfizer: Research Funding. Tran:Pfizer: Honoraria; Bioverativ: Honoraria; Novo Nordisk: Honoraria; Bayer: Honoraria. Wu:Bayer Foundation: Research Funding; Novo Nordisk: Research Funding; Baxalta, now part of Takeda: Research Funding; CSL Behring: Research Funding; Wyeth, now Pfizer: Research Funding. Nichol:Novo Nordisk: Research Funding; CSL Behring: Research Funding; Wyeth, now Pfizer: Research Funding; Bayer Foundation: Research Funding; Baxalta, now part of Takeda: Research Funding.

Arthrofibrosis of the Knee Joint - the Current State of Knowledge. Literature Review.

The objective of the paper is to highlight the interdisciplinary problem of arthrofibrosis (AF) and to present this problem from the physiotherapy angle based on a literature review and the authors' experience. Arthrofi-brosis is a pain-ful condition limiting joint mobility due to pathological fibrosis involving scarring. The limited mobility is often ac-companied by pain. Arthrofibrosis may result in limited locomotion in everyday life or at work and withdrawal from physical activity. In severe cases, Severe AF can lead to patients' unemployability due to their inability to perform certain work-related activities. The problem is important from the clinical point of view, and therefore treatment of AF involves specialists, physiotherapists and psychologists. Our paper presents the definitions of AF, the most fre-quent causes and epidemiology of the dysfunction. This is followed by a classification of arthrofibrosis. Special attention is paid to problems connected with AF-related terminology. The consequences of the disease, such as pain, inflammation and impairment of joint function, especially joint range of motion limitation, are also presented. The relationship between AF and decreased muscle strength is discussed as well as the ways of muscle strength genera-tion and the issue of limited locomotion in patients with this condition. Some emphasis is given to the role of con-servative and surgical treatment as well as physiotherapy for the prevention or reduction of AF consequences. The next section presents the main guidelines for early physiotherapy. The goal of early physiotherapeutic intervention is to prevent excessive fibrosis within the knee joint and enable safe recovery of joint mobility. The conclusions high-light the need to conduct further research and develop a standard for physiotherapeutic intervention within a com-prehensive evidence-based treatment approach to arthrofibrosis.

Randomized placebo-controlled double-blind phase II study of zaltoprofen for patients with diffuse-type and unresectable localized tenosynovial giant cell tumors: a study protocol

BackgroundA tenosynovial giant cell tumor (TGCT) is a locally aggressive benign neoplasm arising from intra- or extra-articular tissue. Diffuse TGCT (D-TGCT) most commonly develops in the knee, followed by the hip, ankle, elbow, and shoulder. Surgical removal is the only effective treatment option for the patients. However, a local recurrence rate as high as 47% has been reported. Recently, we revealed that zaltoprofen, a nonsteroidal anti-inflammatory drug possessing the ability to activate peroxisome proliferator-activated receptor gamma (PPARγ), can inhibit the proliferation of TGCT stromal cells via PPARγ. PPARγ is a ligand-activated transcription factor that belongs to the nuclear hormone receptor superfamily. It plays an important role in the differentiation of adipocytes from precursor cells and exhibits antitumorigenic effects on certain malignancies. Therefore, we are conducting this investigator-initiated clinical trial to evaluate whether zaltoprofen is safe and effective for patients with D-TGCT or unresectable localized TGCT (L-TGCT).MethodsThis study is a randomized, placebo-controlled, double-blind, multicenter trial to evaluate the safety and efficacy of zaltoprofen for patients with D-TGCT or L-TGCT. For the treatment group, zaltoprofen 480 mg/day will be administered for 48 weeks; the placebo group will receive similar dosages without zaltoprofen. Twenty participants in each group are needed in this trial (40 participants total). The primary outcome is the progression-free rate at 48 weeks after treatment administration. “Progression” is defined as any serious events (1. Repetitive joint swelling due to hemorrhage, 2. Joint range of motion limitation, 3. Invasion of adjacent cartilage or bone, 4. Severe joint space narrowing, 5. Increase in tumor size) requiring surgical interventions. We hypothesize that the zaltoprofen group will have a higher progression-free rate compared to that of the placebo group at 48 weeks.DiscussionThis is the first study to evaluate the efficacy of zaltoprofen in patients with D-TGCT or unresectable L-TGCT. We believe that the results of this trial will validate a novel treatment option, zaltoprofen, to stabilize disease progression for TGCT patients.Trial registrationUniversity Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000025901) registered on 4/01/2017.

The effect on upper extremity functions of cardiac electronic device placement on the dominant hand side.

BackgroundAlthough cardiac implantable electronic device (CIED) implantation is considered to be minor surgery, almost 60% of the patients suffer from shoulder‐related problems a short time after the procedure. The purpose of this study was to determine the possible effects of the preference of the dominant side for CIED implantation on the ipsilateral superior extremity functions.MethodsThe study included a total of 107 patients who had been living with a CIED for >6 months. Patients were separated into two groups according to the dominant hand and side of the CIED. The ipsilateral dominant‐hand group comprised those with a CIED on the same side as the dominant hand and the contralateral dominant‐hand group included patients with the CIED placed on the contralateral side to the dominant hand. Visual analogue scale (VAS) pain score, quick disability of the arm shoulder and hand questionnaire (QuickDASH) and maximum isometric grip strength tests were used to evaluate the upper extremity disabilities.ResultsNo significant difference was determined between the groups in respect of VAS pain scores (P = 0.10), QuickDASH scores (P = 0.21), and limitations of the shoulder joint range of motion (P = 0.192). The maximum isometric grip strength was significantly different in the right hands between two groups (34 [16‐95]‐40 [24‐85]) (P = 0.02).ConclusionThe present study shows that the joint range of motion limitation, pain, and disability of the upper extremity were no different in the affected arm compared to the healthy contralateral side with respect to the placement of the CIED on the dominant or non‐dominant side.

State of the Prescription Process for Dynamic Ankle-Foot Orthoses

Purpose of Review Dynamic ankle-foot orthoses (AFOs) are assistive devices that can be prescribed to individuals with mobility limitations to support and align joints. Dynamic AFOs are a category of passive AFOs that can control ankle motion to address both ankle joint range of motion limitations and ankle muscle weakness. This control of motion is achieved through the dynamic AFO’s functional characteristics, namely bending stiffness, which need to be customized to each individual’s needs. However, current conventions for customizing dynamic AFOs for each individual are variable and often not clearly documented. The purpose of this review was to synthesize the current state of customizing functional characteristics of dynamic AFOs to provide a foundation for ultimately optimizing the prescription of AFOs.

The impact of joint range of motion limitations on health-related quality of life in patients with haemophilia A: a prospective study.

In patients with haemophilia A, repeated occurrences of haemarthrosis and synovitis lead to limitations in range of motion (ROM) of major joints. However, the effect of limitations in joint ROM on health-related quality of life (HRQOL) in these patients has not been studied previously. The aim of this study was to assess the impact of ROM limitations of 10 major joints (bilateral shoulders, elbows, hips, knees and ankles), combined with other possibly influential factors, on HRQOL in patients with haemophilia A. The ROM limitations in 13 movements and pain intensity of the 10 major joints were measured. The socio-demographic and clinical data were recorded. Short-Form 36 was used as the HRQOL measurement. Eighteen patients (mean age: 36.9 years) were included. Hip ROM limitations, knee ROM limitations and hip pain intensity predicted physical functioning scale (P < 0.001; adjusted R2 = 0.553). Shoulder ROM limitations and age predicted role limitation were due to emotional problems scale (P < 0.001; adjusted R2 = 0.373). Elbow ROM limitations and haemophilia severity predicted mental health scale (P = 0.001; adjusted R2 = 0.320). Hip ROM limitations predicted social functioning scale (P = 0.041; adjusted R2 = 0.091). Educational level and elbow ROM limitations predicted vitality scale (P < 0.001; adjusted R2 = 0.416). The ROM limitations of hip, knee, shoulder and elbow could be predictors for HRQOL in patients with haemophilia A. Improving ROM of major joints could be an appropriate treatment strategy to enhance HRQOL in these patients.

AB1425-HPR Effects of a yoga program on pain relief, reducing anxiety and extended range of motion of knee in rheumatoid arthritis patients

BackgroundRheumatoid Arthritis as a chronic systemic disease, is the most common cause of joints inflammation and deformity. Chronic pain, fatigue, decline in physical activity and joint range of motion limitation...

Hemophilia Activities List Questionnaire Detects Functional Limitations in Young Adults with Hemophilia A Prior to Physical Examination.

Abstract 1300Poster Board I-322 BackgroundMeasurement of joint range of motion (ROM) identifies hemophilia patients with arthropathy, but may not reflect functional limitations. Methods to detect early functional decline have not been well-studied, but may be important in improving the care of patients with hemophilia. MethodsFunctional status was determined by Hemophilia Activities List (HAL), a self-assessment questionnaire. Normalized scores were calculated & included activities of upper extremities (UE), basic activities of lower extremities (LE), complex activities of LE, leisure activities & summary score. Scores range from 0-100, with 0 representing poor functional status & 100 the best functional status. Joint range of motion (ROM) was measured by goniometry by a single investigator. Overall joint index is calculated as previously described. (Soucie et al, Blood 2004; 103: 2467) Percent of overall joint ROM limitation is calculated as (patient joint index score/normal joint index score) X 100. T-test was performed to assess statistical significance. Results45 adults with Hemophilia A were studied, 33 severe and 12 mild. Mean age was 41, range 21-65. ROM limitations & functional status differed based on disease severity and age. ROM limitations increased and functional status decreased with age among patients with severe hemophilia A (Table), but there was no change in these parameters with age in persons with mild hemophilia (data not shown). Patients with severe hemophilia had decreased functional score in all areas, with lowest score in complex LE activities. The ability to perform basic & complex tasks of LE is decreased in severe hemophilia patients in the 3rd-4th decade when compared to a cohort with mild hemophilia (p<0.001), even though there is no significant decline in LE joint ROM limitations (20% vs 15%, p=0.21).TableDifferences in ROM Limitations and Functional Score between Severe and Mild Hemophilia PatientsMild Age 20-65 n=12Severe Age 20-39 n=15Comparison to Mild p-valueSevere Age 40-69 n=18Comparison to Severe age 20-39 p-valueJoint Bleeds/6 months0110.00290.4ROM LimitationsTotal ROM12%18%0.0131%0.002UE ROM9%16%0.00928%0.004LE ROM15%20%0.2140%0.002Functional Score (HAL)Summary95690.0005550.047Upper Extremities97780.009700.21Basic Lower Extremities95640.0004480.05Complex Lower Extremities88560.001290.002Leisure Activities95670.00154.14 ConclusionsSelf-reported functional limitations are common in severe hemophilia. Functional decline in tasks of the LE begins as early as the third decade of life, & occurs before significant limitations in joint ROM are detected. Therefore a self-reported questionnaire can be useful in detection of early disability in adults with hemophilia. Future studies should focus on early detection and treatment interventions to prevent further functional decline. DisclosuresNo relevant conflicts of interest to declare.

Radiosynovectomy in Hemophilic Synovitis: Correlation of Therapeutic Response and Blood-Pool Changes

The aim of this study was to evaluate the efficacy of 90Y and 186Re radiosynovectomy in patients with hemophilic synovitis. Radiosynovectomy was performed in 32 joints of 20 patients with hemophilic synovitis by using 90Y citrate colloid in the knee and 186Re sulfide colloid in the elbow, shoulder, and ankle. The indication for radiosynovectomy was the continuous presence of intra-articular blood or effusion and three or more hemorrhages into the same joint within the last 6 months. Response to therapy was first assessed at the 4th month with blood-pool imaging. Patients were followed up by clinical evaluation based on assessments of joint-bleeding frequency, using range of motion measurements at 6-month intervals for an average of 1 year (range, 9-15 months). A marked decrease (an 80%-100% decrease) in bleeding episodes was seen in 24 of 32 (75%) joints, a moderate decrease (51%-79% decrease) in 1 (9%) joint, and a mild decrease (30%-50%) in 3 (13%) joints. Frequency of intra-articular bleeding after treatment was unchanged in only 13% of the joints. The number of hemarthroses significantly decreased after therapy (p < 0.05). The mean bleeding frequency of the joints were 1.7 +/- 0.9 and 0.3 +/- 0.7 per month before and after therapy, respectively. The ratios of joints which had marked improvement after therapy were 86% in the ankle, 73% in the elbow, and 58% in the knee. There was no significant difference between percent joint range of motion limitations measured before and after therapy (p > 0.05). The correlation between therapeutic outcome (in terms of joint bleeding) and the difference of pre- and posttherapeutic blood-pool indices were significant (r = 0.594; p < 0.05), while the correlation between therapeutic outcome and pretherapeutic radiologic scale and pretherapeutic blood-pool indices were not significant (r = 0.095; p > 0.05; r = -0.089; p > 0.05, respectively). Radiosynovectomy is a simple but quite effective and efficient procedure in limiting the frequency of joint hemorrhage in patients with hemophilia. Blood-pool imaging may be an objective means for monitoring therapy response in these patients.

Joint range of motion limitations in children and young adults with spinal muscular atrophy

Abstract Wang HY, Ju YH, Chen SM, Lo SK, Jong YJ. Joint range of motion limitations in children and young adults with spinal muscular atrophy. Objectives To elicit descriptive data about limited joint range of motion (ROM) in subjects with type II or III spinal muscular atrophy (SMA) and to examine the relation between the number of motions with limited range and both age and functional ability. Design Descriptive cross-sectional study. Setting Neurologic pediatric outpatient clinic at a hospital in Taiwan. Participants Twenty-seven subjects with SMA type II (mean age, 9.8±6.5y) and 17 with SMA type III (mean age, 12.2±8.7y). Intervention Measurement with transparent goniometers of joint ROM bilaterally of the shoulder, elbow, wrist, hip, knee, and ankle. Main outcome measures The proportion of participants with each ROM limitation compared with all participants with the same SMA type, age distribution of the participants with each ROM limitation, mean range loss of each motion limitation, and the contracture index (risk index of joint contracture). Results Eighty-nine percent of the participants with SMA type II experienced knee extension limitation. Approximately 50% of the participants with both types of SMA had ankle dorsiflexion limitation. The motions of knee and hip extension and ankle dorsiflexion also had a relatively high contracture index. The number of motions with limited range positively correlated ( P<.001) with age and upper-extremity functional grade (the higher the functional grade, the poorer the functional ability) for SMA type II. Conclusions We found varying degrees of joint ROM limitation. Certain motions were noted to be high risks for the development of contractures. This risk was higher mostly in younger children.

Human parvovirus B19 in young male patients with hemophilia A: associations with treatment product exposure and joint range-of-motion limitation.

To evaluate the risk of human parvovirus B19 (B19) transmission in recombinant antihemophilic factor, the seroprevalence among 798 two- to seven-year-old boys with hemophilia was compared. Also, data collected on joints were used to assess relations between B19 serostatus and joint range-of-motion (ROM) limitation. Staff at US hemophilia treatment centers collected data on product exposures and ROM of 10 joints and provided blood specimens as part of blood safety surveillance. Blood was tested for immunoglobulin G anti-B19. Associations between B19 seropositivity and treatment products and joint ROM limitations were examined in multivariate analyses. Compared to children who received no product, the odds of B19 seropositivity were 0.8 (p = 0.5), 1.9 (p = 0.05), and 7.6 (p < 0.001) for those children who received recombinant antihemophilic factor only, both recombinant antihemophilic factor and plasma-derived factor, and plasma-derived factor only, respectively. Children who were anti-B19 positive had an average 8 degrees less overall ROM (p = 0.002) than those who were B19 antibody negative after adjustment for other risk factors. The risk of B19 transmission by recombinant antihemophilic factor is low. Previous B19 infection is associated with ROM limitations in very young male patients with hemophilia. Virus inactivation techniques effective against B19 and other nonenveloped viruses are needed.

Joint range-of-motion limitations among young males with hemophilia: prevalence and risk factors

AbstractChronic joint disease from repeated bleeding into joints is a serious complication of hemophilia. To measure the extent of and to identify risk factors for deviations from normal in joint range of motion (ROM), we used cross-sectional data collected from 4343 males with hemophilia aged 2 to 19 years who received care at 136 US hemophilia treatment centers (HTCs). Factors examined included age, race/ethnicity, family history, insurance status, age at diagnosis and first HTC visit, frequency of HTC visits, hemophilia type, bleeding frequency, prophylaxis use, inhibitor status, body mass index (BMI), and recent orthopedic procedures. Trained personnel using a standard protocol obtained ROM measurements on 10 joints (hips, knees, shoulders, elbows, and ankles). Analyses used multiple linear regression to model overall ROM limitation separately by disease severity. For persons in all severity groups, joint ROM limitation was positively associated with older age, nonwhite race, and increased BMI. For those with severe disease, ROM limitation was also positively associated with number of bleeds and was greater for those with inhibitors or recent orthopedic procedures. We conclude that ROM limitations begin at an early age, especially for those with severe and moderate disease, and that BMI is an important, potentially modifiable risk factor.