Reduction Of Joint Mobility Research Articles

Clinical Evaluation of Neck in Patients with Proprioceptive Cervicogenic Dizziness.

To establish a functional connection between neck physical evaluations, dizziness discomfort and image findings among subjects diagnosed with proprioceptive cervical dizziness. After exclusion of peripheral vestibular disorders, 20 subjects with proprioceptive cervical dizziness hypothesis were selected. A Visual Analogue Scale (VAS) was used to quantify pain and vertigo. The active neck Range of Motion (ROM) and the Muscle Strength (MS) of the neck region were examined. The manipulation of vertebral bodies by the Maitland method and imaging scan were performed. A positive correlation between pain and vertigo VAS scores was found. The ROM of the cervical spine was limited and vertebral joint movement was restricted, especially at C3 and C5. No loss of MS was noticed. Proprioceptive cervical dizziness is usually an exclusion diagnosis among episodic chronic vertigos. Characteristically, it is reported by patients as instability or vertigo in crises. It is directly related to the neck ache severity and worsens with neck movements. The common pattern on clinical examination includes restriction and pain during neck flexion without loss of MS. Reduction of joint mobility and pain are also observed, especially at C3 and C54 kHz.

A mathematical model appraising the effect of metabolic control on joint mobility in young diabetic patients: a preliminary study

Objective. The impairment of glycemic control can induce limited joint mobility even in young type 1 diabetic (T1DM) patients. The aims of this study were to verify the presence of ankle joint mobility (AJM) deficits in young T1DM subjects and define a mathematical model of diabetes mellitus long-term effects on AJM. Methods. AJM was evaluated using an inclinometer in 37 patients and 53 healthy, sex- BMI- and age-matched controls. To set up the mathematical model, we assumed that reduced metabolic control affects AJM according to a lognormal function: requiring some time for development of a reduction of joint mobility, which then persists for a long period, before fading out over time (if glycemic control has been recovered). A non-linear optimization determined the model parameters to achieve the best fit for a series of patients. Results. Both plantar and dorsiflexion AJM was significantly lower in diabetic subjects than in controls (plantarflexion: 28.5°±7.5 vs 35.2°±6.5; dorsiflexion: 93.9°±16.0 vs 104.7±12.8; p<0.01). The defined model approximates the experimental data with good accuracy; after optimization, the lognormal curve obtained is in line with empirical estimates: lack of glycemic control needs to persist for at least a few months before producing a significant effect, that lasts up until one year. The fitting procedure indicated the optimal solution is p = (37; 30; 3:5; 6:7; 137); thus, the optimal _im(t) corresponds to the curve reported. Conclusion. AJM was significantly reduced in young T1DM patients. The mathematical model represents the experimental data accurately.

Stretch for the treatment and prevention of contractures.

Contractures are a common complication of neurological and non-neurological conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective. This review is an update of the original 2010 version of this review. The aim of this review was to determine the effects of stretch on contractures in people with, or at risk of developing, contractures.The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions, spasticity and adverse events. In November 2015 we searched CENTRAL, DARE, HTA; MEDLINE; Embase; CINAHL; SCI-EXPANDED; PEDro and trials registries. We included randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing contractures. Two review authors independently selected trials, extracted data, and assessed risk of bias. The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions and adverse events. We evaluated outcomes in the short term (up to one week after the last stretch) and in the long term (more than one week). We expressed effects as mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). We conducted meta-analyses with a random-effects model. We assessed the quality of the body of evidence for the main outcomes using GRADE. Forty-nine studies with 2135 participants met the inclusion criteria. No study performed stretch for more than seven months. Just over half the studies (51%) were at low risk of selection bias; all studies were at risk of detection bias for self reported outcomes such as pain and at risk of performance bias due to difficulty of blinding the intervention. However, most studies were at low risk of detection bias for objective outcomes including range of motion, and the majority of studies were free from attrition and selective reporting biases. The effect of these biases were unlikely to be important, given that there was little benefit with treatment. There was high-quality evidence that stretch did not have clinically important short-term effects on joint mobility in people with neurological conditions (MD 2°; 95% CI 0° to 3°; 26 studies with 699 participants) or non-neurological conditions (SMD 0.2, 95% CI 0 to 0.3, 19 studies with 925 participants).In people with neurological conditions, it was uncertain whether stretch had clinically important short-term effects on pain (SMD 0.2; 95% CI -0.1 to 0.5; 5 studies with 174 participants) or activity limitations (SMD 0.2; 95% CI -0.1 to 0.5; 8 studies with 247 participants). No trials examined the short-term effects of stretch on quality of life or participation restrictions in people with neurological conditions. Five studies involving 145 participants reported eight adverse events including skin breakdown, bruising, blisters and pain but it was not possible to statistically analyse these data.In people with non-neurological conditions, there was high-quality evidence that stretch did not have clinically important short-term effects on pain (SMD -0.2, 95% CI -0.4 to 0.1; 7 studies with 422 participants) and moderate-quality evidence that stretch did not have clinically important short-term effects on quality of life (SMD 0.3, 95% CI -0.1 to 0.7; 2 studies with 97 participants). The short-term effect of stretch on activity limitations (SMD 0.1; 95% CI -0.2 to 0.3; 5 studies with 356 participants) and participation restrictions were uncertain (SMD -0.2; 95% CI -0.6 to 0.1; 2 studies with 192 participants). Nine studies involving 635 participants reported 41 adverse events including numbness, pain, Raynauds' phenomenon, venous thrombosis, need for manipulation under anaesthesia, wound infections, haematoma, flexion deficits and swelling but it was not possible to statistically analyse these data. There was high-quality evidence that stretch did not have clinically important effects on joint mobility in people with or without neurological conditions if performed for less than seven months. Sensitivity analyses indicate results were robust in studies at risk of selection and detection biases in comparison to studies at low risk of bias. Sub-group analyses also suggest the effect of stretch is consistent in people with different types of neurological or non-neurological conditions. The effects of stretch performed for periods longer than seven months have not been investigated. There was moderate- and high-quality evidence that stretch did not have clinically important short-term effects on quality of life or pain in people with non-neurological conditions, respectively. The short-term effects of stretch on quality of life and pain in people with neurological conditions, and the short-term effects of stretch on activity limitations and participation restrictions for people with and without neurological conditions are uncertain.

Clinical and radiological presentation of a child with progressive pseudorheumatoid dysplasia

The role of WNT pathway in bone formation and maintenance has been extensively studied since the identification of mutations in key signalling WNT mediators in diseases with high or low bone-mass phenotypes. In humans, loss-of-function mutations in WISP3, encoding Wnt1-inducible signaling protein 3, cause progressive pseudorheumatoid dysplasia (PPD), an autosomal recessive form of spondyloepiphyseal dysplasia tarda. Individuals with PPD appear normal at birth, have subtle clinical symptoms by 3 years of age and develop later a severe degenerative joint disease with multiple contractures and reduction in joint mobility. Radiologically patients with PPD have multiple sites of epiphyseal enlargement in addition to platyspondyly.

Obesity and worsening of chronic venous disease and joint mobility

The aim of this study was to investigate a possible relationship between obesity and decreased mobility of the talocrural joint and in turn chronic venous disease. One hundred obese patients recruited at Hospital Santa Casa de Maringa, Parana were enrolled by order of arrival at the hospital in a randomized quantitative cross-sectional study. Inclusion criteria were patients with a body mass index above 30 kg/m(2) and the exclusion criteria were infectious conditions that would interfere with the assessment. Patients were graded according to the clinical, etiological, anatomical and pathophysiological classification. Talocrural goniometry was performed to assess the degree of mobility of the legs. The Kolmogorov-Smirnov normality test, Kruskal-Wallis test, Dunn's Multiple comparison test and analysis of variance were used for statistical analysis tests with an alpha error of 5% being considered acceptable. The increase in body mass index is correlated to the reduction in joint mobility (Kruskal-Wallis test: p-value <0.0001) and increase in clinical, etiological, anatomical and pathophysiological classification is correlated to a decrease in joint mobility and the increase in age is associated with an increase in clinical, etiological, anatomical and pathophysiological classification (Kruskal-Wallis test: p-value <0.0001). Obesity is associated with deterioration in joint mobility and worsening of chronic venous disease.

Donor site morbidity of free ulnar forearm flap

The purpose of this study was to evaluate the donor site morbidity of the free ulnar forearm flap (UFF). Consecutive patients undergoing free UFF between 1982 and 2009 were retrospectively reviewed. In addition, detailed assessment of hand function and donor site cosmesis was performed in the most recent 50 patients followed up for at least 12 months. In all, 62 of the 242 free UFF donor sites (26%) were closed directly and the remainder required split thickness skin grafting. Donor site complications included total (n = 1) and partial (n = 17) skin graft loss and persistent hypertrophic scarring (n = 4). There was minimal incidence of cold intolerance, parasthesia, and pain; no reduction in joint mobility, grip and pinch strength, and sensory dysfunction, with excellent donor site cosmesis. UFF has several advantages, including the possibility of direct closure of the donor defect, and reduced morbidity and excellent donor site cosmesis.

Interaction between Trigger Points and Joint Hypomobility: A Clinical Perspective

The relationship between muscle trigger points (TrPs) and joint hypomobility is frequently recognized by clinicians. Among different manual therapies aimed at inactivating muscle TrPs, ischemic compression and spinal manipulation have shown moderately strong evidence for immediate pain relief. Reduction of joint mobility appears related to local muscles innervated from the segment, which suggests that muscle and joint impairments may be indivisible and related disorders in pain patients. Two clinical studies have investigated the relationship between the presence of muscle TrPs and joint hypomobility in patients with neck pain. Both studies reported that all patients exhibited segmental hypomobility at C3-C4 zygapophyseal joint and TrPs in the upper trapezius, sternocleidomastoid, or levator scapulae muscles. There are several theories that have discussed the relationship between TrP and joint hypomobility. First, increased tension of the taut muscular bands associated with a TrP and facilitation of motor activity can maintain displacement stress on the joint. Alternatively, it may be that the abnormal sensory input from the joint hypomobility may reflexively activate TrPs. It is also conceivable that TrPs provide a nociceptive barrage to the dorsal horn neurons and facilitate joint hypomobility. There is scientific evidence showing change in muscle sensitivity in muscle TrP after spinal manipulation, which suggests that clinicians should include treatment of joint hypomobility in the management of TrPs. Nevertheless, the order in which these muscle and joint impairments should be treated is not known and requires further investigation.

Hypertrophie rotulienne: rare anomalie associée à une dysplasie polyépiphysaire

Multiple epiphyseal dysplasia is a genotypic chondrodystrophy characterized by an abnormal shape of numerous epiphyses. Diagnosis is usually made during childhood on an abnormal gait and a reduction of joint mobility associated with radiological changes of the ossification centres. This observation reports on a woman who only consulted at adulthood. Diagnosis was based on a short stature, slight shortening of the extremities and precocious osteoarthritis on the radiographs. Lateral x-rays of the knees revealed a globular hypertrophy of both patellae. This association has rarely been mentioned. A late fusion of an antero-posterior duplication of the ossification centre of the patella seems to be the most plausible physiopathologic hypothesis. Persistence of both ossification centres could result in a coronal double-layered patella, which is also occasionally observed in patients with multiple epiphyseal dysplasia.

Inhibition of Keratinocyte-Driven Contraction of Tissue-Engineered Skin In Vitro by Calcium Chelation and Early Restraint But Not Submerged Culture

Skin graft contracture remains a significant cause of patient morbidity with reduction in joint mobility and cosmetic deformity. Despite recent advances, its mechanism is largely unknown. The authors have previously demonstrated the importance of the keratinocyte in the contraction of tissue-engineered skin in vitro. In this study, they investigate the effect of reducing keratinocyte differentiation on contraction by adding 0.8 mM ethylene glycol-bis(2-aminoethylether)-N,N,N',N'-tetra acetic acid (EGTA) to the culture medium and by culturing tissue-engineered skin submerged in medium rather than at air-liquid interface. They also simulate the effect of early mechanical splinting in vitro to study its effect on contraction. Here the study shows that removal of the epidermis after 16 days culture at air-liquid interface results in immediate dermal relaxation with a return to the original dermal surface area. Lowering extracellular calcium concentration with EGTA reduces keratinocyte differentiation and reduces the rate of contraction. Submerged culture does not significantly reduce differentiation of tissue-engineered skin and does not reduce contraction. However, following an initial short period of mechanical constraint, the rate of contraction of tissue-engineered skin is reduced. Reducing keratinocyte differentiation by lowering extracellular calcium with EGTA, reduces contraction. However, submerged culture of tissue-engineered skin is ineffective. A short period of splinting of meshed skin grafts during the initial phase of epithelialization and keratinocyte differentiation may be most effective in the prevention of subsequent contractures in vivo but additional studies are needed to establish this.

Relação entre a mobilidade da articulação talocrural e a úlcera venosa

CONTEXTO: O presente estudo avalia a mobilidade da articulação talocrural nos seis estágios clínicos da classificação CEAP (clínica, etiológica, anatômica e patofisiológica do International Consensus Committee Reporting Standards on Venous Disease) para doença venosa utilizando a goniometria, e detecta redução da mobilidade articular nos estágios mais avançados da doença, C5 e C6 (úlcera cicatrizada ou ativa). OBJETIVO: Investigar a existência de uma relação entre a severidade clínica da doença venosa crônica dos membros inferiores e a diminuição do grau de mobilidade da articulação talocrural. MÉTODO: Selecionaram-se aleatoriamente 120 membros pertencentes a 88 pacientes brancas, que foram separados com base em sua apresentação clínica de acordo com a categoria C da classificação CEAP, sendo distribuídos em 6 grupos pertencentes às categorias de C0-C1 (grupo controle) até C6, com 20 membros cada um e médias de idade próximas para cada grupo. O grau de mobilidade do tornozelo foi acessado por goniometria de apoio plantar em posição de decúbito supino. RESULTADOS: Os grupos C de CEAP apresentam diferença significativa em relação ao grau de mobilidade da articulação talocrural medida por goniometria (p &lt; 0,001). C6 difere significativamente dos demais grupos (p &lt; 0,05); C5 difere significativamente de C6, C3, C2 e C0-C1 (p &lt; 0,05), mas não apresenta diferença significativa do grupo C4; C4 difere significativamente do grupo C6 (p &lt; 0,05) e não difere dos demais grupos; C0-C1, C2 e C3 não apresentam diferença significativa entre si e em relação a C4, e diferem dos grupos C5 e C6 (p &lt; 0,05). O nível de significância utilizado para os testes foi de 5%. CONCLUSÃO: Existe relação entre a severidade clínica da insuficiência venosa crônica dos membros inferiores e a diminuição do grau de mobilidade da articulação talocrural, e ela se faz mais evidente na presença de úlcera venosa ativa ou cicatrizada.

Editorial

Cartilage lesions, caused by trauma or as a result of knee instability or abnormal loading are a common cause of disability, often associated with pain, reduction of joint mobility and loss of function. Given the limitations of traditional surgical techniques such as lavage and debridement, bone marrow stimulation techniques and mosaicplasty newer surgical approaches have been developed focused at obtaining the regeneration of hyaline cartilage into the defect site and its complete functional integration with the surrounding tissues, to restore the normal knee function and provide durable outcomes.

A graphical presentation of three-dimensional joint mobility

Reduction of joint mobility in humans is a very common medical condition which results from trauma or joint disease. However, there is currently no satisfactory way of plotting the three-dimensional rotations which completely define this mobility. The most usual method of presenting the results from the many systems for measuring joint mobility is to plot graphs of the three angles of rotation, individually, against time, or to plot two angles of rotation against one another. However, this latter excludes the third angle of rotation which has to be presented separately. This paper suggests a technique known as the hemispherical projection method for the plotting of three-dimensional joint mobility data. The technique is derived from the fields of structural geology and rock mechanics where it is used for presenting and analysing orientation information on discontinuity planes in rock. Data from human hip and spine movements have now been successfully plotted using a microcomputer. This will provide an opportunity for straightforward comparison of movements between individuals and patient groups using the shape of the output graphs as a clinical aid. In addition, it is suggested that ‘indices of mobility’ may be derived from the plots. These indices could be used to quantify joint disability using the area enclosed by, and the asymmetry of, the plot.

Limited joint mobility in diabetes mellitus.

The relationship of limited joint mobility and finger joint contractures in diabetics to age of onset, duration, and control of diabetes has not been established. We measured the mobility of metacarpophalangeal, wrist, elbow, and ankle joints and assessed the prevalence of finger joint contractures in 254 young diabetics and 110 controls. The presence of microvascular disease was assessed by ophthalmoscopy and urine analysis for proteinuria. An estimate of long-term diabetic control was obtained from a postal questionnaire. A generalised reduction in joint mobility was present in diabetics of all ages two years after diagnosis. The reduction in joint mobility in controls between the ages of 12 and 13 was exaggerated in the diabetics. Diabetics diagnosed before puberty were more severely affected than those with a postpubertal onset, independent of duration of diabetes. Finger joint contractures were a significant feature of longstanding diabetics (nine years or more duration) only.

Arthroscopic synovectomy in the treatment of hemophilic synovitis.

Chronic proliferative synovitis is a frequent complication of hemophilia for which effective treatments are lacking. Over a three year period we employed arthroscopic surgery on 7 knees in 6 patients with hemophilic synovitis refractory to standard treatment including anti‐inflammatory drugs, prophylactic factor infusion and physical therapy. Operative findings included diffuse villous synovial proliferation covering most cartilagenous surfaces of joint spaces in all six cases, varying degrees of articular erosion, osteochondral defects, and various forms of meniscal tear. One patient with an advanced degree of arthropathy had an extensive scar and interarticular fibrous band adhesions. Peri‐operatively morbidity was minimal, permitting early institution of physical therapy. Joint effusion resolved within one month of surgery. During the 6 month to 3 year post‐operative follow‐up, bleeding frequency was markedly reduced in all cases. In contradistinction to open surgical synovectomy, which encountered an unacceptably high incidence of post‐operative reduction in joint mobility, the range of knee joint motion after arthroscopic synovectomy was well preserved or improved in 4 of 6 patients. Two patients have lost the range of knee joint motion in post‐arthroscopic follow‐up; one patient sustained a tibial fracture requiring a long leg cast on the same knee, and the other had severe arthropathy with a reduced range of motion prior to arthroscopy. All patients have experienced pain relief and improved knee function. We conclude that arthroscopic synovectomy is a promising treatment of chronic hemophilic synovitis of the knee with low surgical morbidity and with long‐term benefit comparable to or better than that reported with open synovectomy.