Purpose: We assess the mid to long term follow up results of arthrodesis of the first metatarso-phalangeal (MTP) joint and resection arthroplasty of the lesser toes in rheumatoid arthritic forefoot deformity. Materials and Methods: Between 1998 to 2001 year, 25 cases (18 patients) rheumatoid forefoot deformities were surgically corrected. Follow up period was 83 months (range, 63 to 90 months). The clinical outcome was evaluated using subjective satisfaction and AOFAS score. The radiological measurements were hallux valgus angle, first and second intermetatarsal angle, second metatarso-phalangeal angle (MTP-$2^{nd}$ angle). Results: Subjective satisfaction was 76%. AOFAS score improved from 37 to 73. The hallux valgus angle improved from preoperative $39^{\circ}$ ($27{\sim}64^{\circ}$) to $14^{\circ}$ ($4{\sim}34$) at the last follow up. The intermetatarsal angle were preoperative $13^{\circ}$ ($6{\sim}22^{\circ}$) to $11^{\circ}$ ($3{\sim}13^{\circ}$) at the last follow up, The MTP-$2^{nd}$ angle were preoperative $24^{\circ}$ ($9{\sim}47$) to last follow up $15^{\circ}$ ($2{\sim}39^{\circ}$) respectively (p>0.05). Complication was intractable callus 10 cases, Interphalangeal arthritis 5 cases. Conclusion: Mid to long term outcomes rheumatoid forefoot reconstruction by first MTP arthrodesis and resection arthroplasty of lesser toes results a satisfaction and pain relief.
We recently demonstrated that bee venom (BV) injection into acupoint (i.e. Zusanli) produced more potent anti-inflammatory and antinociciptive effect in Freunds adjuvant induced rheumatoid arthritis (RA) model as compared with that of non-acupoint injection(i.e back). However, the precise components underlying BV-induced antinociceptive and/or anti-inflammatory effects have not been fully understood. Therefore, we further investigated the anti-arthritic effect of BV after extracting the whole BV according to solubility (water soluble: BVA, ethylacetate soluble: BVE). Subcutaneous BVA treatment (0.9 mg/kg/day) into Zusanli acupoint was found to dramatically inhibit paw edema and radiological change (i.e. new bone proliferation and soft tissue swelling) caused by Freunds adjuvant injection. In addition, the increase of serum interleukin-6 by RA induction was normalized by the BVA treatment as similar with that of non-arthritic animals. On the other hand, BVA therapy significantly reduced arthritis induced nociceptive behaviors (i.e., nociceptive score for mechanical hyperalgesia and thermal hyperalgesia). Furthermore, BVA treatment significantly suppressed adjuvant induced Fos expression in the lumbar spinal cord at 3 weeks post-adjuvant injection. However, BVE treatment (0.05 mg/kg/day) has not any anti-inflammatory and anti-nociceptive effect on RA. Based on the present results, we demonstrated that BVA might be a effective fraction in whole BV for long-term treatment of RA-induced pain and inflammation. However, it is clear necessary that further fraction study about BVA was required for elucidating an effective component of BVA.
Background: The purpose of the current study was to investigate short- to mid-term outcomes and complications following radial head replacement (RHR) for complex radial head fractures and to identify factors associated with clinical outcomes. Methods: Twenty-four patients with complex radial head fractures were treated by RHR. The mean age of the patients was 49.8 years (range, 19-73 years). Clinical and radiographic outcomes were evaluated for a mean follow-up period of 58.9 months (range, 27-163 months) using the visual analog scale (VAS) score for pain, the Mayo elbow performance score (MEPS), the quick disabilities of the arm, shoulder and hand (Quick-DASH) score, and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, the mean VAS score, MEPS, and Quick-DASH score were 0.6±1.1, 88.7±11.5, and 19.4±7.8, respectively. The mean range of motion was 132.7° of flexion, 4.7° of extension, 76.2° of pronation, and 77.5° of supination. Periprosthetic lucency was observed in six patients (25%). Heterotopic ossification was observed in four patients (16.7%). Arthritic change of the elbow joint developed in seven patients (29.2%). Capitellar wear was found in five patients (20.8%). Arthritic change of the elbow joint was significantly correlated with MEPS (P=0.047). Four cases of complications (16.6%) were observed, including two cases of major complications (one stiffness with heterotopic ossification and progressive ulnar neuropathy and one stiffness) and two cases of minor complications (two transient ulnar neuropathy). Conclusions: RHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high.
Objectives : This study was performed to investigate the effects of Gamichangbaek-san(Jiaweichangbai-san) on anti-inflammatory, analgesic, anti-febrile and immune response on the arthritis of carrageenan-induced animals. Methods and Materials : Rats were classified into control and sample groups which are 7 individuals each for the experiments about anti-inflammatory and anti-febrile. Each of the 7 mice were classified into normal, control, sample groups for the analgesic experiments. Gamichangbai-san(Jiaweichangbai-san) was administered to sample group and normal saline was administered to normal and control groups. Arthritis was induced by injection of 1% carrageenan $0.1m{\ell}$ and Gamichangbaek-san(Jiaweichangbai-san) was administered after 30 minutes. The change of edema in Carrageenan-induced Arthritic Rats' Paws was measured after 1 hour and 5 hours from the injection of carraqeenan with Plethysmometer(7150, UGO BASILE, ltaly) by Winter' method. WBC, Lymphocyte and ESR were measured by heart puncture and CD4+ T cell, CD8+ T cell and CD4+/CD8+ T cell ratio were measured from the spleen tissue. Writhing syndrom was measured with Tail flick unit(UGO BASILE, Italy) in the experiments conducted to check the analgesic activity. The temperature of the paws of carrageenan-induced arthritic rats was measured by Laser thermometer. Rectal temperature was measured by Yeast's method in anti-febrile experiments. Immune response was measured by CD4+, CD8+ T cell ratio and CD4+/CD8+ T cell ratio. Results : 1. It was recognized that Gamichangbaek-san(Jiaweichangbai-san) decreased the increase rate of Paw Edema effectively with statistical significance. 2. It was recognized that Gamichangbaek-san(Jiaweichangbai-san) decreased WBC, Lymphocyte and ESR with statistically high significance. 3. It was recognized that Gamichangbaek-san(Jiaweichangbai-san) did not show significant analgesic effect, but the Pressure pain threshold of the paws was increased with statistical significance. 4. It was recognized that Gamichangbaek-san(Jiaweichangbai-san) decreased rectal temperature effectively and had an anti-febrile effect about the febrile of a joint with statistical significance. 5. It was recognized that Gamichangbaek-san(Jiaweichangbai-san) increased CD4+ T cell ratio with statistically high significance and increased CD+8 T cell ratio with statistical non significance but increased CD4+/CD8+ T cell ratio effectively with statistical significance, too. Conclusions : According to the above results, it can be concluded Gamichangbaek-san(Jiaweichangbai-san) showed the treatment effects on the artificial arthritis resulted from carageenan in rats and it is suggested that more interest and study in the security for the clinical use were needed.
Although there are many research studies on the effectiveness of heat and cold therapy for patients with arthritis at home or health care center, little attention has been paid to determining which therapy associates with season is effective for patients with chronic arthritis. The purpose of this study was to explore the effectiveness of heat and cold therapy associated with season for patients with arthritis. An experimental design using replications with intervention was employed. A total of 27 female arthritic patients were selected. Data were collected in summer and winter. Hot bag and ice bag were applied on each patient's knee for each 20 minutes alternatively. Joint pain, discomfort and range of motion were measured. Data were analyzed using paired t-test, and two-way ANOVA. The results of this study were ; 1. Joint pain Heat therapy was effective for pain relief, as compared with cold therapy. Heat therapy was more effective for pain relief in winter than in summer. Cold therapy was effective for pain relief, but there was no statistically significant difference of pain relief between summer and winter. 2. Discomfort Discomfort was decreased using heat therapy, whereas it was increased using cold therapy. Although discomfort was decreased using heat therapy in both summer and winter, there was no statistically significant difference of discomfort between summer and winter. Using cold therapy, discomfort was decreased in summer, but increased in winter. and season had effect on discomfort. 3. Range of motion Although there was no statistically significant difference between the range of motion for both heat and cold therapy, range of motion was Increased using both heat and cold therapy. In winter, range of motion was increased rather than in summer by using heat therapy. Using cold therapy, The range of motion was decreased in both summer and winter. There was no stastistically significant difference of range of motion between heat therapy and cold therapy. Furthermore, there was no statistically significant difference of range of motion between summer and winter. In conclusion, both heat and cold therapy were effective for pain relief, discomfort, and range of motion, especially heat therapy. Heat therapy was effective for pain relief, discomfort, and range of motion in winter, as compared with summer. Cold therapy, however, was effective for only pain relief in winter, The findings suggest the use of heat therapy for patients with arthritis especially in winter.
Purpose: The purpose of the study was to identify the effects of a 9-week self-help management aquatic exercise program on pain, flexibility, balance, fatigue and self-efficacy in the patients with osteoarthritis living in the suburban area. Methods: Utilizing a quasi-experimental design, 43 osteoarthritis patients consisted of the experimental group (n=20) and the control group (n=23). Due to the busy schedule of the patients working in the farm, the program was provided for 9 weeks instead of 12 week program under the guidance of professional advice. The questionnaires and physical measurements were used to measure the outcome variables before and after the program. Data were analyzed with the SPSS WIN using descriptive statistics, t-test and ANCOVA. Results: The age was significantly different between the groups. After controlling for the age, pain and fatigue in the experimental group decreased significantly more than the control group. Flexibility, balance and self-efficacy in the experimental group improved significantly more than the control group. Conclusion: This 9-week program could be an effective nursing intervention to be used especially for osteoarthritis patients in the suburban area during the leisure seasons of the farmers to improve their arthritic symptoms and self-efficacy.
Purposes of this study were to identify a hospital-based home care model and to improve the physical, emotional and economical effectiveness of arthritic patients through medical and nursing team approach. The design in nonequivalent control group pretest-posttest design with matched samples in terms of age, sex and disease severity. Fifty two patients in each group were assigned in Seoul, Kyunggi, Kangwon and Kwangju. Before and after 6-month period of home care, level of pain, duration of morning stiffness, Richie Index, ADL, self efficacy, depression, cost expenditure were measured. Nine patients were excluded from the control group in the period of study because of denial of participation. Contents of home care provided to the experimental group include mainly distribution of prescribed drugs, 'assessment of patients' condition and side-reactions of drug. All of the information related to the home care patient were reported to the physician. On the bases of these data, the physician prescribe the specific drugs to each patient. Each patient visited the physician every 2 or 3 month for laboratory test. Patients assigned to the control group visited the outpatient clinic once a month as usual. Null hypotheses were selected because physicians concerned about the ineffective change of patients' conditions due to indirect communication with patients through nurses. Level of pain, Richie index, ADL, self-efficacy, depression, duration of morning stiffness and direct medical cost were the home care provided to them. If a family member accompany in a home care group can save 10,676 Won/month in Seoul, 34,000 Won/month in other districts. Other in-direct cost for transportation and meal can also be saved. In conclusion, those patients with low level of ADL, high level of pain and Richie index, living in the remote area definitely need the home care.
Purpose: The purpose of the study was to compare the effects of the Tai Chi self-help program with a self-help program on pain, stiffness, physical functioning, and fear of falling in women with osteoarthritis. Method: Total of 82 women with Osteoarthritis recruited from outpatient clinics or community health centers were randomly assigned either to a Tai Chi self-help group or a self-help group. Thirty subjects in the Tai Chi self-help group and 39 in the self-help group completed posttest measures(pain, stiffness, physical functioning, and fear of falling) at 6 months. Results: After the 6 month study period, the subjects in the Tai Chi self-help group reported significantly less difficulties in performing daily activities(mean difference=-0.16 vs. 6.19 for the self-help), and less fear of falling(mean difference=-3.20 vs. 0.27 for the self-help) than those in the self-help group. There were no significantly differences in pain and stiffness between the groups. Conclusion: The Tai Chi combined with self-help program was more effective than the self-help only program in reducing difficulties in performing daily activities and fear of falling in women with Osteoarthritis. Whether these changes prevent fall episodes requires further study.
The results of the operative treatment of the Grade III acromioclavicular joint injury is defined by the durability of the reduced joint and free of exertional pain. Several surgical techniques have been applied to reduce and stabilize the joints effectively. Resection of clavicular lateral end and subacromial decompression also could be applied to prevent post-operative arthritic change. Biomechanical studies reveals the role of clavicular elevation and rotation to achieve more than 90 degrees of elevation. It also serves as a attachment site of deltoid and trapezius muscle. The stability and mobility of the both acromioclavicular and coracoclavicular joint are important to get full functional recovery. We modified the methods of coracoacromial ligament transfer described by Weaver-Dunn and by Shoji et a!. to prevent pullout of the transferred ligament and to get more improved functional results. Main technical point was harvesting full thickness bone block and fix it through the key-hole to reduce pull out angle.
Kim, Sang-Woo;Choi, Joon-Hyuk;Kim, Min-Su;Chang, Chul-Hoon
Journal of Korean Neurosurgical Society
/
v.49
no.4
/
pp.237-240
/
2011
Ganglion cysts usually arise from the tendon sheaths and tissues around the joints. It is usually associated with degenerative arthritic changes in older people. Ganglion cyst in the spine is rare and there is no previous report on case that located in the intervertebral foramen and compressed dorsal root ganglion associated severe radiculopathy. A 29-year-old woman presented with severe left thigh pain and dysesthesia for a month. Magnetic resonance imaging revealed a dumbbell like mass in the intervertebral foramen between second and third lumbar vertebrae on the left side. The lesion was removed after exposure of the L2-L3 intervertebral foramen. The histological examination showed fragmented cystic wall-like structure composed of fibromyxoid tissue but there was no lining epithelium. A ganglion cyst may compromise lumbar dorsal root ganglion when it located in the intervertebral foramen. Although it is very rare location, ganglion cyst should be included in the differential diagnosis for intervertebral foraminal mass lesions.
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