Identification of prognostic indicators for patient outcomes in extensor tendinopathy at the elbow.

Extensor tendinopathy is a degenerative overuse condition involving the common extensor tendon at the lateral humeral epicondyle. The diagnosis and management of this condition are clinically based. Our aims were to determine if through patient history and clinical examination we could ascertain prognostic factors affecting time to symptom resolution in extensor tendinopathy.

Topical glyceryl trinitrate treatment of chronic noninsertional achilles tendinopathy. A randomized, double-blind, placebo-controlled trial.

Background: Noninsertional Achilles tendinopathy is a degenerative overuse disorder. No method has been universally successful in treating this condition. Topically applied nitric oxide has been shown, in animal models, to be effective for the treatment of fractures and cutaneous wounds through mechanisms that may include stimulation of collagen synthesis in fibroblasts.

Diagnostic values of tests for acromioclavicular joint pain.

Background: This prospective study was performed to determine which clinical and imaging tests were most helpful for diagnosing acromioclavicular joint pain.

Methods: Of 1037 patients with shoulder pain, 113 who mapped pain within an area bounded by the midpart of the clavicle and the deltoid insertion were eligible for inclusion in the study. Forty-two subjects agreed to participate, and four of them were lost to follow-up.

Cell therapy for disc degeneration--potentials and pitfalls.

Disc degeneration is considered a major source of pain in patients with chronic low back pain. Novel strategies to cure or decrease the symptoms and increase the patient's quality of life and function are under development. Until recently conservative treatment and fusion surgery were the main therapeutic options.

Shoulder stiffness: management.

Background: There are several causes of painful, stiff shoulders--each with a different method of treatment.

Objective: This article summarises the methods available to treat the various causes of stiff shoulders.

Discussion: Impingement and partial thickness rotator cuff tears can be treated by the general practitioner with a subacromial steroid injection.

Shoulder stiffness: diagnosis.

Background: Pain and stiffness of the shoulder is a common complaint, particularly in the 40-80 years age group. There are several causes of painful, stiff shoulders, but the most common cause in the fifth decade of life is idiopathic capsulitis ('frozen shoulder').

Objective: This article summarises the functional anatomy of the shoulder joint, the pathology of the conditions that lead to shoulder stiffness, and methods to differentiate them.

Percutaneous vertebroplasty for acute vertebral body fracture and deformity in multiple myeloma: a short report.

We describe seven patients with multiple myeloma who were treated for acute vertebral body fractures with percutaneous vertebroplasty to a total of 14 vertebrae. Six of the seven patients had at least a 50% decrease in their pain scores at 24 h following vertebroplasty. There were no procedure-related complications.

Osteoporosis in men with prostate carcinoma receiving androgen-deprivation therapy: recommendations for diagnosis and therapies.

Background: Androgen-deprivation therapy (ADT) is prescribed with increasing frequency for men with prostate carcinoma. There is growing concern about the effects of such therapy on the skeleton. In the current review, the authors addressed the current research, diagnostic methods, and treatment recommendations for bone loss and osteoporosis in men with prostate carcinoma who received ADT.

The Orthopaedic Research Institute-Tennis Elbow Testing System: A modified chair pick-up test-interrater and intrarater reliability testing and validity for monitoring lateral epicondylosis.

Lateral epicondylosis is a degenerative overuse tendinopathy involving the extensor tendons of the forearm, predominantly the extensor carpi radialis brevis, in the region of the lateral epicondyle of the elbow. The Orthopaedic Research Institute-Tennis Elbow Testing System (ORI-TETS) is designed to record objective measurements of force generated with a simulated chair pick-up test. Interrater reliability of the ORI-TETS was excellent, with high intraclass correlation coefficients (ICCs) for right arm mean peak force of 0.

An assessment of the interexaminer reliability of tests for shoulder instability.

Accurate noninvasive clinical tests of shoulder instability are important in assessing and planning treatment for glenohumeral joint instability. An interexaminer agreement trial was undertaken to estimate the reliability of commonly used clinical tests for shoulder instability. Thirteen patients with a history suggestive of instability, who had been referred to a shoulder specialist for treatment of their symptomatic shoulders, were examined by four examiners of differing experience.

A critical appraisal of quantitative arthroscopy as an outcome measure in osteoarthritis of the knee.

Background And Objectives: To review the performance of arthroscopic assessment of articular cartilage damage in osteoarthritis.

Methods: The literature was reviewed for publications containing data regarding validity and reliability of arthroscopic systems of cartilage evaluation in knee osteoarthritis.

Results: Fifty-two distinct measurement systems were identified in 60 publications.

Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial.

Background: Extensor tendinosis ("tennis elbow") is a degenerative overuse tendinopathy of the wrist extensors at their attachment to the lateral humeral epicondyle. No treatment has been universally successful. Topical application of nitric oxide has been used effectively to treat fractures and cutaneous wounds in animal models, presumably by stimulation of collagen synthesis in fibroblasts.

The rotator cuff: biological adaptations to its environment.

The rotator cuff is a common source of shoulder pain in individuals who rely on overhead activities for work and sport. As diagnostic and treatment measures continue to advance, it is important for the physician to retain a knowledge of the anatomy and biological properties of the rotator cuff in its surroundings. The collagen composition, proteoglycan and glycosaminoglycan content, and cellular activity of the rotator cuff reflect its mechanical function.

Meniscal and chondral loss in the anterior cruciate ligament injured knee.

Rupture of the anterior cruciate ligament (ACL) of the knee is a commonly occurring injury in the athletic population. Associated meniscal and chondral injury is well recognised. This occurs both at the time of index injury and also secondarily over time in the ACL-deficient knee as a result of several related pathways culminating in osteoarthritis.

Cell death and tendinopathy.

Apoptosis and necrosis are presently recognized as the two major types of physiological and pathological cell death. Apoptosis is a tightly regulated cell deletion process that differs morphologically and biochemically from necrotic cell death. Tendinopathy is defined as a tendon injury that originates from intrinsic and extrinsic etiological factors.

Addition of nitric oxide via nitroflurbiprofen enhances the material properties of early healing of young rat Achilles tendons.

Objective And Design: To determine if the addition of nitric oxide (NO) via nitroflurbiprofen (NO-flurbiprofen) would enhance rat Achilles tendon healing.

Materials And Methods: Sixty-five male Sprague-Dawley rats were randomly divided into NO-flurbiprofen, flurbiprofen and vehicle groups, given drugs or vehicle subcutaneously, and their right Achilles tendon divided. Histological assessment was carried out at day 5, 10, and 15 post-operation.

Temperature trends in total hip arthroplasty: a retrospective study.

The purpose of this study was to define the temporal trend in body temperature of patients during the first 5 days after total hip arthroplasty (THA). The medical records of 98 consecutive THAs were reviewed, 88 clinically uncomplicated cases were included. The average maximum temperature reached during the study period was 38.

Adenovirus-mediated gene transfer to healing tendon--enhanced efficiency using a gelatin sponge.

Adenovirus-mediated gene transfer is a potential method for enhancing tendon healing. We investigated the transfection of Ad5CMVntLacZ, an adenovirus containing the reporter gene LacZ, in primary cultured human rotator cuff tendon cells and in a rat Achilles tendon healing model in vivo. Ad5CMVempty, the adenoviral vector containing no inserted gene, was used as a control for adenoviral transfection alone.

Involvement of cytochrome c release and caspase-3 activation in the oxidative stress-induced apoptosis in human tendon fibroblasts.

Our previous studies have demonstrated that oxidative stress and apoptosis are involved in human tendon degeneration. The objectives of our current study were to investigate the effect of oxidative stress on human tendon cell apoptosis, and to explore pathways by which tendon cell apoptosis was induced. In vitro oxidative stress was created by exposure of cultured human rotator cuff tendon cells to H(2)O(2).

The roles of growth factors in tendon and ligament healing.

Tendon healing is a complex and highly-regulated process that is initiated, sustained and eventually terminated by a large number and variety of molecules. Growth factors represent one of the most important of the molecular families involved in healing, and a considerable number of studies have been undertaken in an effort to elucidate their many functions. This review covers some of the recent investigations into the roles of five growth factors whose activities have been best characterised during tendon healing: insulin-like growth factor-I (IGF-I), transforming growth factor beta (TGFbeta), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and basic fibroblast growth factor (bFGF).

Accuracy and reliability of arthroscopic estimates of cartilage lesion size in a plastic knee simulation model.

Purpose: The goal of the study was to determine the accuracy and reliability of arthroscopic percent area estimates in a plastic knee simulation model. A second goal was to determine the effect of lesion location within the knee and lesion size on accuracy and reliability.

Type Of Study: Cross-sectional study of arthroscopic estimates of cartilage lesion size.

Topographical analysis of the structural, biochemical and dynamic biomechanical properties of cartilage in an ovine model of osteoarthritis.

Objective: The relationship between the topographical variations in the structural, biochemical and dynamic biomechanical properties of articular cartilage (AC) before and 6 months after meniscectomy has not been previously reported but is clearly relevant to our understanding of the role of mechanical factors on the pathogenesis of osteoarthritis (OA). The objective of this study was to address this deficiency using an ovine model of OA induced by bilateral lateral meniscectomy.

Design: The dynamic effective shear modulus (G*) and phase lag were determined ex vivo at 26 individual locations over the medial and lateral tibial plateaux of non-operated and meniscectomized ovine joints 6 months after surgery using a novel hand-held dynamic indentation probe.

Apoptosis in rotator cuff tendonopathy.

The aim of this study was to investigate the involvement of apoptosis (programmed cell death) in the pathogenesis of rotator cuff disorders. The edges of torn supraspinatus rotator cuff tendons were collected from patients with rotator cuff tear (n = 25). Samples of the intra-articular portion of subscapularis tendons were collected from patients without rotator cuff tear as control (n = 6).

Shoulder instability: management and rehabilitation.

Shoulder dislocation and subluxation occurs frequently in athletes with peaks in the second and sixth decades. The majority (98%) of traumatic dislocations are in the anterior direction. The most frequent complication of shoulder dislocation is recurrence, a complication that occurs much more frequently in the adolescent population.

The unstable shoulder in the adolescent athlete.

Shoulder dislocation and subluxation occur frequently in athletes, with peaks in the second and sixth decades. The majority of traumatic dislocations are in the anterior direction. The most frequent complication of shoulder dislocation is recurrence--a complication that occurs much more often in the adolescent population.