Limited Range Of Motion Research Articles

Prognostic Factors in Intra-articular Platelet-Rich Plasma Treatment for Knee Osteoarthritis: A Comparative Analysis of Responders and Nonresponders.

Knee osteoarthritis (KOA) is a chronic joint disease affecting activities of daily living (ADL) and quality of life due to pain and limited range of motion, afflicting a large number of patients worldwide. However, it is difficult to prevent the progression of the disease. Therapeutic strategies for KOA aim to maintain ADL and QOL by alleviating pain or managing locomotive function. Recently, intra-articular injection of platelet-rich plasma (PRP) has been gaining attention. In this study, the clinical results of PRP treatment in our institution were reported and compared between responders and non-responders using patient characteristics and imaging data assessed from plain X-rays and magnetic resonance imaging (MRI). Participants in the study were KOA patients with varus deformity assessed as grade 2 or higher in the Kellgren-Lawrence classification who received PRP treatment from January 2022 to November 2023 and were followed up for at least three months. PRP was prepared with 27 mL of blood collected from the patient, and 2.7 mL of PRP was prepared using the PEAK©︎PRP System from DePuy Synthes (Raynham, MA). Intra-articular injections of PRP were performed under echo-guided procedures, and responders or non-responders were determined using the Osteoarthritis Research Society International Standing Committee for Clinical Trials Response Criteria Initiative (OMERACT-OARSI) criteria evaluated by the Japanese Knee Injury and Osteoarthritis Outcome Score (J-KOOS) at three months after PRP injection. The clinical efficacy of PRP treatment for KOA was assessed in this study, and a dichotomous analysis was performed comparing the responder group and the non-responder group using patient characteristics and assessed data from plain X-ray images and MRI to determine prognostic factors for PRP treatment. The study population included 36 knees with a mean age of 70.6. ± 9.2 years, comprising six knees in men and 30 knees in women. The responder group consisted of16 knees (44.4%), and the non-responder group consisted of 20 knees (55.6%).J-KOOS subscores at pre-treatment elicited that each subscale in the R group was significantly lower than that in the NR group at pretreatment. A dichotomous analysis for the two groups revealed the distribution of sex and past medical history of hyperlipidemia to be significantly different between the two groups. Multivariable logistic regression analysis showed that the coexistence of hyperlipidemia was the main prognostic factor for the efficacy of PRP therapy. In this study, comparisons were conducted between responders and non-responders to estimate prognostic factors for the efficacy of PRP therapy. Surprisingly, responders to the treatment tended to show lower J-KOOS scores and to have hyperlipidemia. A literature review revealed conflicting reports on prognostic factors for PRP therapy in KOA, highlighting the need for further research.

Analysis of postoperative complications 5 years after osteosynthesis of patella fractures—a retrospective, multicenter cohort study

PurposeThe study aims to investigate the influence of patient- and fracture-specific factors on the occurrence of complications after osteosynthesis of patella fractures and to compare knee joint function, activity, and subjective pain levels after a regular postoperative course and after complications in the medium term.MethodsThis retrospective, multicenter cohort study examined patients who received surgery for patella fracture at level 1 trauma centers between 2013 and 2018. Patient demographics and fracture-specific variables were evaluated. Final follow-up assessments included patient-reported pain scores (NRS), subjective activity and knee function scores (Tegner Activity Scale, Lysholm score, IKDC score), complications, and revisions.ResultsA total of 243 patients with a mean follow-up of 63.4 ± 21.3 months were included. Among them, 66.9% of patients underwent tension band wiring (TBW), 19.0% received locking plate osteosynthesis (LPO), and 14.1% underwent screw osteosynthesis (SO). A total of 38 patients (15.6%) experienced complications (TBW: 16.7%; LPO: 15.2%; SO: 11.8%). Implant-related complications of atraumatic fragment dislocation and material insufficiency/dislocation, accounted for 50% of all complications, were significantly more common after TBW than LPO (p = 0.015). No patient-specific factor was identified as a general cause for increased complications. Overall, particularly following complications such as limited range of motion or traumatic refracture, functional knee scores were significantly lower and pain levels were significantly higher at the final follow-up when a complication occurred. Implant-related complications, however, achieved functional scores comparable to a regular postoperative course without complications after revision surgery.ConclusionThe present study demonstrated that implant-related complications occurred significantly more often after TBW compared to LPO. The complication rates were similar in all groups.

Prognosis of Pain After Stroke During Rehabilitation Depends on the Pain Quality.

Pain after a stroke interferes with daily life and the rehabilitation process. This study aimed to clarify the prognosis of pain in subgroups of patients with pain after a stroke using pain quality data. The study included 85 patients with pain after stroke undergoing exercise-based rehabilitation. Items of the Neuropathic Pain Symptom Inventory (NPSI) were used, and patients with pain after stroke were clustered according to their scores of NPSI. Other clinical assessments, such as physical and psychological conditions, were assessed by interviews and questionnaires, and then these were compared among subgroups in a cross-sectional analysis. Longitudinal pain intensity in each subgroup was recorded during 12weeks after the stroke and the patients' pain prognoses were compared between subgroups. Four distinct subgroups were clustered: cluster 1 (cold-evoked pain and tingling), cluster 2 (tingling only), cluster 3 (pressure-evoked pain), and cluster 4 (deep muscle pain with a squeezing and pressure sensation). The cross-sectional analysis showed varying clinical symptoms among the subgroups, with differences in the prevalence of joint pain, limited range of motion, somatosensory dysfunction, and allodynia. There were no significant differences in pain intensity at baseline among the subgroups. A longitudinal analysis showed divergent prognoses of pain intensity among the subgroups. The pain intensity in cluster 4 was significantly alleviated, which suggested that musculoskeletal pain could be reduced with conventional exercise-based rehabilitation. However, the pain intensity of patients in clusters 1 and 2 remained over 12weeks. The study classified patients into clinically meaningful subgroups using pain quality data and provided insight into their prognosis of pain. The findings could be useful for guiding personalized rehabilitation strategies for pain management. Assessment of pain quality in patients with pain after stroke leads to personalized rehabilitation for pain management.

Effectiveness of PNF Pattern in Regular Physical Therapy Sessions on Functional Mobility in Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is a musculoskeletal condition that presents with symptoms such as discomfort, nocturnal pain, and limited range of motion. Abduction and external rotation are significantly reduced. Objective: To investigate the effectiveness of combining proprioceptive neuromuscular facilitation (PNF) patterns into routine physical therapy sessions for patients with frozen shoulder. Methods: A six-week quasi-experimental study was conducted on a total of 30 participants, divided into group A (n=15) and group B (n = 15), selected from the outpatient department (OPD). Pain, disability, and range of motion were evaluated as outcome measures. The group A received proprioceptive neuromuscular facilitation (PNF) patterns in addition to their usual physical therapy sessions, and group B only received conventional physical therapy sessions. Disabilities of the Arm, Shoulder and Hand (DASH), VAS (Visual Analog Scale) and goniometer were used to assess pain, disability and range of motion (ROM). Data were analyzed using SPSS version 23.0. Results: Both groups showed a significant reduction in DASH and VAS scores and an increase in ROMs, as group A showed a better result in terms of DASH score and abduction range (p<0.05). Conclusions: Both the experimental and control groups had statistically significant outcomes. The PNF pattern and Codman exercises both have a positive impact on rehabilitation. However, PNF is more advanced because it involves a combination of movements that are also useful in daily activities. Additionally, PNF helps develop memory for correct patterned movements. On the other hand, Codman exercises are only effective for retaining and improving shoulder ranges.

Comparative Effectiveness of Muscle Energy Technique (MET) With or Without Proprioceptive Neuromuscular Facilitation (PNF) Pattern in Lumbosacral Dysfunction

Lumbosacral dysfunction is a condition affecting the lumbar and sacral regions of the spine, causing back pain, limited range of motion, sensory deficits, and motor impairments. It can be caused by degenerative changes, traumatic injuries, congenital anomalies, or abnormal biomechanics. Objective: The objective of this study was to compare the effects Muscle Energy Technique (MET) alone and with combination of PNF in treating lumbosacral syndrome. Methods: The study was a quasi-experimental design over the duration of 8 weeks. Purposive sampling was employed with a sample size of 40 patients, divided equally into Group A (N= 20) who received MET combined with PNF and Group B (N= 20) that only received MET. We used Oswestry Disability Index (ODI), Numeric Pain Rate Scale (NPRS) and goniometer to assess disability, pain, and range of motion (ROM). We analyzed the data using IBM SPSS version 23.0. Results: Outcome measures including pain intensity, functional disability, and range of motion, were assessed at baseline and post-intervention (8 weeks). The group A showed significant improvements in all outcome measures compared to the group B at post-intervention assessments (p < 0.05), pain intensity decreased by 60-80%. Functional disability scores were reduced by 60-75% in the group A, while the group B showed only 40% significant change. Moreover, the group A exhibited a substantial increase in lumbosacral range of motion compared to the group B. Conclusions: The study reveals that both MET alone and MET combined with PNF effectively improve pain, functional disability, and lumbar range of motion in lumbosacral dysfunction patients.

Effect of mobilization and rotator cuff strengthening in frozen shoulder: A review of literature

The term frozen shoulder refers to a painful and worsening shoulder condition characterized by stiffness and limited range of motion. Adhesive capsulitis, also known as this ailment, is a condition characterized by glenohumeral joint restriction, pain, and limited range of motion. The presence of intracapsular fibrosis complicates this condition by affecting range of motion (ROM), pain, and inflammation. This review evaluated joint mobilization with strengthening exercise interventions for adhesive capsulitis, focusing on ROM, discomfort, and function. The review used peer-reviewed papers, randomized controlled trials, quasi-experimental research, and clinical trials adapted from multiple databases. The movement with mobilization (MWM) approach is a potential intervention that improves outcomes related to frozen shoulder, especially when combined with rotator cuff strengthening interventions. The analysis concludes by highlighting the advantages and efficacy of mobilization in conjunction with rotator cuff strengthening for enhancing muscle strength and the overall results in cases of frozen shoulder. The evidence-based conclusions highlight the promising results of this combination strategy in effectively managing and treating frozen shoulder, addressing the study limitations, and offering suggestions for future research.

Utility of fast MRIs in pediatric elbow injuries

BackgroundPediatric elbow trauma presents a diagnostic challenge for clinicians. Radiographs may be insufficient in assessing the radiocapitellar alignment and advanced imaging or invasive procedures such as an intraoperative arthrogram may be indicated. The purpose of this study is to describe the application and utility of fast magnetic resonance imaging (MRI) in the diagnosis and management of traumatic elbow injuries in pediatric patients. MethodsWe reviewed pediatric patients who underwent a fast MRI of the elbow between 2014-2022. A fast MRI was defined as an MRI using rapid sequences, accelerated conventional sequences, or fewer conventional sequences than a standard exam. Imaging for chronic or non-traumatic injuries was excluded. We identified patient demographics, MRI scan times, and clinical course. ResultsTwenty-three patients (8 females and 15 males) with fast elbow MRI scans were identified. The mean age was 5 years (range 2-12 years, SD 2 years). All patients had radiographs and four had CT scans prior to MRI. The average scanning time was 14 minutes (SD 6 minutes). Only one patient required anesthesia. Twenty of the 23 patients had a fracture identified on elbow radiographs and 8 were Monteggia fracture-dislocations. Nine of these patients demonstrated subluxation of the radiocapitellar joint requiring operative management in 8 patients, and one additional patient underwent surgery for displaced radial neck fracture. Three patients sustained an elbow dislocation without fracture identified on radiographs; of these, one had persistent radiocapitellar subluxation on MRI requiring surgical management. A total of 13 patients (56.5%) did not require operative management based on fast MRI findings. Outcome data was available for 22 patients with mean follow up was 23.6 months. One patient had residual pain and 8 had some range of motion limitation at final follow-up. All patients had reduced elbow joint on follow-up radiographs. ConclusionsFast MRIs can assist with the clinical evaluation of acute elbow injury in pediatric patients with equivocal radiographic findings and particularly in those with possible radiocapitellar subluxation/dislocation. This novel imaging technique has the potential to change clinical management, decrease the need for unnecessary procedures, and prevent complications of missed injuries.

A hybrid ankle-foot orthosis with soft pneumatic actuation

This paper presents the design, development, and analysis of a powered ankle-foot orthosis for dorsiflexion assistance which aims to improve gait restoration by addressing issues related to orthosis misalignment, limited degrees of freedom, restricted range of motion, and muscular disuse. The proposed orthosis utilizes a novel hybrid design with a combination of both traditional and soft robotics for compliant and unrestrictive ankle dorsiflexion assistance for sufferers of footdrop. This article describes the complete design of the orthosis including analytical modeling and experimental testing of the soft pneumatic actuator and the development of gait phase detection and ankle angular feedback systems using wearable sensors for accurate and responsive control. Preliminary analysis was completed which validates the orthosis as a lightweight, unrestrictive, and compliant device that is capable of dorsiflexing the ankle of a person up to 100 kg, and at walking speeds appropriate for safe and effective community ambulation of up to 1.04 m/s. The novel design of the device demonstrates the potential for improved rehabilitative outcomes for patients with footdrop, due to the ability to adjust the assistive force of the device, throughout the progression of rehabilitation, which encourages muscular participation of the user and therefore reduces issues caused by muscular disuse.

Conservative Treatment in Neer Type II Distal Third Clavicle Fracture: A Case Report

Introduction: Clavicle fractures, common among young athletes, often result from falls onto the shoulder. The Neer classification guides treatment decisions based on ligament and joint involvement. While older studies favored nonoperative treatment, recent research suggests surgery may be beneficial, especially for certain fractures. Recommendations vary, with non-surgical options for non-displaced fractures and surgery for displaced distal third fractures, particularly type II and V. The choice between operative and non-operative management remains debated, as both may yield similar functional outcomes. Case report: A 38-year-old hotel manager presented with left shoulder pain following a motorcycle accident. Examination revealed a displaced fracture of the left clavicle, with tenderness and limited range of motion. Despite the fracture, he opted for nonoperative management with an arm sling. At three weeks, his pain improved, and X-rays showed better alignment. By six weeks, pain and stiffness had subsided, and X-rays indicated callus formation. At 18 weeks, he had full range of motion and strength, with visible callus formation on imaging. He continued physiotherapy for optimal recovery. Discussion: In recent years, managing clavicular fractures has shifted towards open reduction and internal fixation (ORIF) due to high non-union rates with conservative treatment. A 38-year-old man with a displaced Neer type II distal third clavicle fracture chose nonoperative treatment despite controversy. He showed significant improvement after six weeks, opting for physiotherapy. Conclusion: Limitations include the fracture occurring in a non-dominant upper limb and the rarity of Neer type II clavicular fractures, warranting further research. Keywords: Clavicle fracture, Neer type II clavicular fracture, conservative treatment.

Pathomechanisms, Pathophysiology and Biomechanics of Degenerative Spine Disease: A Review of Literature

The intervertebral disc in human being is a complex structure and is made up of fibrous and cartilaginous tissues. It is characterized as tension-resisting structure while it allows limited range of motion in axial, bending or rotational posture. Degenerative process of this structure present with clinical morbidity to the patients and possess great challenges to the clinicians while offering care for disc’s pathology. Degeneration begins with imbalance of homeostasis maintained by content of nucleus pulposus and annulus fibrosus. Numerous factors; genetic, mechanical and nutritional, can initiate and or accelerate this degeneration process which ultimately alter the biomechanics of the spine. The aim of this review is to give an overview on the degeneration process, causes and factors influencing disc degeneration, the mechanisms of degeneration and the changes resulted from intervertebral disc degeneration.

Delayed debridement affects prognosis in patients with purulent flexor tenosynovitis: a retrospective cohort and multivariate analyses.

Purulent flexor tenosynovitis (PFT) is a severe condition, and many patients report serious postoperative complications such as amputation, limited range of motion (ROM), or recurrence of symptoms. However, the ideal protocol for PFT treatment remains unknown owing to the limited number of studies. This retrospective cohort study aimed to identify prognostic factors for PFT treatment outcomes. Sixty-six patients (46 men and 20 women) with PFT who underwent surgical debridement at our hospital between September 2005 and January 2023 were included in this study. We conducted multivariate linear regression analysis with permanent deficit as the primary outcome. We defined the number of operations, laboratory data, interval from onset to debridement, previous conservative treatment, aetiology, Kanavel's signs, and medical history of diabetes mellitus as possible prognostic factors. We also defined the interval from onset to debridement as a secondary outcome and performed logistic regression analysis. Overall, 25 (38%) patients had postoperative deficits. Longer interval from onset to surgery (odds ratio [OR]: 1.1, 95% confidence interval [CI]: 1.0-1.1) and polymicrobial infection (OR: 7.8, 95% CI: 1.56-38.8) were significant prognostic factors for unfavourable outcomes. Additional multivariate analysis showed that preoperative conservative treatment prolonged the interval to surgery (estimate, 16.4; standard error, 1.6; p < 0.05). The results of this study suggest that indications for nonoperative treatment of PFT are limited and that earlier surgical debridement is recommended.

The New Double-row Bankart Repair Recovered Shoulder Stability without Excessive Motion Limitation: A Case-Control Study with Single-row Bankart Repair.

Bankart lesion is one of the most common lesions of the glenohumeral joint. Several double-row suture methods were reported for Bankart repair, which could provide more stability, yet more motion limitation and complications. Therefore, we introduced a new double-row Bankart repair technique, key point double-row suture which used one anchor in the medial line. The purpose of this article is to investigate the clinical outcomes of this new method and to compare it with single-row suture. Seventy-eight patients receiving key point double-row suture or single-row suture from October 2010 to June 2014 were collected retrospectively. The basic information including gender, age, dominant arm, and number of episodes of instability was collected. Before surgery, the glenoid bone loss was measured from the CT scan. The visual analogue scale, American shoulder and elbow surgeons, the University of California at Los Angeles shoulder scale, and subjective shoulder value were valued before surgery and at the last follow-up. Forty-four patients (24 patients receiving single-row suture and 20 patients receiving key point double-row suture) were followed up successfully. The follow-up period was 9.2 ± 1.1 years (range, 7.8-11.4 years). At the last follow-up, no significant differences were detected for any of the clinical scores. The recurrence rate was 12.5% for the single-row group and 10% for the double-row group, respectively (p = 0.795) 14 patients (31.8%) in the single-row group and nine patients (26.5%) in the double-row group were tested for active range of motion. A statistically significant difference was found only for the internal rotation at 90° abduction (48.9° for single-row and 76.7° for key point double-row, p = 0.033). The key point double-row sutures for Bankart lesions could achieve similar long-term outcomes compared with single-row suture, and one medial anchor did not result in a limited range of motion. The low recurrence rate and previous biomechanical results also indicate the key point double-row suture is a reliable method.

The intra- and inter-rater reliability of measuring trunk coronal asymmetry by adjusting positioning variability: A prospective study.

Chronic low back pain (LBP) can lead to muscle spasms, limited range of motion, and abnormal posture, resulting in trunk muscle asymmetry. This study aimed to assess the intra- and inter-rater reliability of a quantitative measurement of trunk coronal asymmetry in patients with chronic LBP, minimizing unnecessary gravity and friction force using a manual table in the prone position. This prospective study was conducted at a single center, targeting patients with chronic LBP to measure trunk coronal asymmetry on a manual table in the prone position. The intra-class correlation coefficient (ICC) was calculated using one-way random-effects and two-way mixed-effects models. Fifty-eight patients who had LBP for more than three months were enrolled from May 1, 2021, to December 31, 2021. The intra- and inter-rater reliabilities of the two examiners' measurements were 0.872 and 0.899, and 0.852, respectively. Based on pain severity, the participants were classified into mild and severe groups, with ICCs of 0.823 and 0.889, and 0.936 and 0.918, respectively. Measurement of trunk coronal asymmetry in the prone position using a manual table demonstrates high intra- and inter-rater reliability. In addition, the reliability increases with greater pain severity.

Physiotherapy Management of Total Knee Replacement Et Causa Osteoarthritis Genu with Transcutaneous Electrical Nerve Stimulation Modalities and Exercise Therapy in Banten Provincial Hospital

Osteoarthritis is a chronic disease that most often occurs in elderly people aged over65 years. The age-standardized incidence of knee OA is 3.8% worldwide and 80% ofpatients over 75 years of age have radiologically proven OA. Knee osteoarthritissufferers usually complain of pain, swelling, limited joint mobility, and stiffness due toinflammation of the synovial joints. OA of the knee can also cause disruption offunctional activity and interference with patient work (Thacoor &amp; Sandiford, 2019).This research aims to find out more about the benefits of using TENS in reducing painand the benefits of exercise therapy in increasing the range of motion of joints andincreasing lower leg muscle strength as a result of total knee replacement. This type ofresearch is descriptive and action research with the subject Ny. I with medical recordsPost total knee replacement dextra surgery. Results of the physiotherapy managementprocess for Total knee replacement et causa osteroarthritis knee dextra withTranscutaneus Nerve Stimulation and exercise therapy in Ny. 1, aged 53 years, came tothe Banten Provincial Regional Hospital in November with the problem of pain in theright knee, limited range of motion of the joint, decreased muscle strength, anddecreased functional activities such as squatting and going up and down stairs. Afterundergoing physiotherapy six times from November 16, 2022 to December 19, 2022using Transcutaneal Electrical Nerve Stimulation (TENS) and Exercise Therapy, theresults showed that the level of pain had decreased, the range of motion of the jointshad increased, muscle strength had increased, and the patient's functional activity hadimproved. has increased, although not completely. It is hoped that education andhome programs, independent exercises given by therapists to patients must always beimplemented with family support to get maximum results and remind patients aboutwhat is recommended by the physiotherapist for the patient's recovery and recovery.

Tarsal Coalition: Surgical Management in the Young Athlete.

Tarsal coalition is an abnormal bony, cartilaginous, or fibrous bridge between 2 or more tarsal bones. Adolescent athletes with tarsal coalitions typically present with symptoms that include foot and/or ankle pain and limited range of motion. Loss of mobility can lead to abnormal loading, articular instability, deformity, and joint degeneration. Nonoperative management includes immobilization, physical therapy, and custom foot orthosis. Surgical options include coalition excision and fat graft interposition, foot realignment, or a combination of these. Surgical treatment requires evaluation of the coalition type, foot alignment, and degenerative changes in the adjacent joints.

An osteopathic approach for a patient with sequela after treatment for a cheek squamous cell carcinoma

Abstract Surgical and radiation treatment for head and neck cancer are associated with both chronic and acute pain. While traditional treatment options, commonly antiepileptics and opioids, can be effective, many patients may still experience significant and debilitating pain. This case report describes a 61-year-old woman with a past medical history of spindle type squamous cell carcinoma in the left cheek that metastasized to the left parotid and submandibular glands. She was treated with surgical excision followed by radiation. She presented to the Osteopathic Manipulative Medicine clinic with the complaint of severe left sided facial pain, and limited range of motion that resolved with osteopathic manipulation.

A common tumour at an uncommon location: Lesser trochanter osteochondroma

Osteochondromas are benign osteocartilaginous tumours, which are developmental abnormalities rather than actual neoplasms. The lesser trochanter is an extremely rare location for a solitary osteochondroma, and depending on the tumour’s size, the patient can exhibit various symptoms, including a limited range of motion. This case study describes a rare instance of a benign solitary osteochondroma of the lesser trochanter identified and managed using an excisional biopsy following Ludloff’s approach. With intraoperative fluoroscopy, we could accurately outline and remove the entire tumour mass without endangering the nearby essential tissues.

Extreme Serum Titanium Concentration Induced by Acetabular Cup Failure: Unveiling a Unique Scenario of Titanium Alloy Debris Accumulation.

The majority of contemporary total hip arthroplasty (THA) implants are constructed from Ti alloys, which are generally believed to generate fewer adverse local tissue reactions (ALTRs) compared to CoCr alloys. This study presents a case of unusual primary THA failure where a substantial release of Ti alloy debris was observed. A 52-year-old active male underwent THA after post-traumatic aseptic necrosis of the femoral head in 2006. Seventeen years after the procedure, the patient presented with groin pain and a restricted range of motion. X-rays revealed the protrusion of the alumina ceramic head through the Ti6Al4V acetabular cup. Trace element analysis indicated significantly elevated levels of serum Ti, Al, and V. CT and MRI confirmed Ti alloy cup failure and a severe ALTR. During revision surgery, it was found that the worn-out ceramic head was in direct contact with the acetabular cup, having protruded through a central hole it had created over time. No acetabular liner was found. Histological analysis of his tissue samples showed wear-induced synovitis with areas of multinucleated foreign body giant cells and the accumulation of numerous metal particles but no acute inflammatory response. Six months after the revision THA, the patient has experienced favourable outcomes. This case provides an instructive illustration for studying the consequences of the substantial release of Ti alloy debris from orthopedic implants.

Complex Case: Acute-on-Chronic Gouty Arthritis, Septic Arthritis, and Severe Joint Deformities in a Young Adult Patient

Background: Gout is the most prevalent type of inflammatory arthritis, which can lead to inflammation in the joints. However, septic arthritis is unusual in gout.&#x0D; Case presentation: A 34-year-old male presented with lumps on the right ankle with cloudy white fluid discharge for 5 days prior to admission. The patient also has lumps observed on the left pedis, and manus bilateral. The patient regularly takes Allopurinol daily and Piroxicam prior to admission. The physical examination had a limited range of movement. Laboratory examinations found elevated uric acid, impaired renal function, elevated white blood cells, and elevated erythrocyte sedimentation rate. The patient was then referred for surgical debridement.&#x0D; Conclusion: Chronic gout marked by persistent polyarticular engagement and the formation of tophi. In individuals left untreated, septic arthritis and gout may manifest, followed by deformities of joints, which need further diagnosis and management.

The epidemiological profile of temporomandibular joint disorders in the Tunisian population: A cross-sectional study

ObjectiveThis study aimed to explore the prevalence, signs, and symptoms of different types of TMD (Temporomandibular joint disorders) disorders in Tunisian patients. MethodsA retrospective cross-sectional study was conducted using the clinical records of patients from the Department of Functional Exploration, Pain, and Orofacial Dysfunction of the Dental Clinic of Monastir. ResultsTMD is associated with a female predominance, with a peak prevalence among those aged between 20 and 40 years. Pain and a limited range of motion were significantly more prevalent in women (p = 0.019 and p = 0.012, respectively). Clicking sounds were the most frequent joint noises (38.2 %). Crepitus was more prevalent among older adults (33 %). Of the different types of TMD, disk displacement with reduction was the most prevalent (n = 216, 39 %). Sleep bruxism was more prevalent than awake bruxism (20.7 % VS 9.5 %). Due to the heterogeneous TMD signs and symptoms, patients tend to seek medical attention from various specialties (e.g. neurology and otolaryngology). ConclusionThe prevalence of different types of TMD, and the different signs and symptoms varied depending on sociodemographic characteristics, such as sex, age and lifestyle. Diagnosis is challenging and TMD may be confused with other orofacial pain conditions.