Osteoporosis detection in the community. Are patients adequately managed?

In conclusion, osteoporosis remains underdiagnosed in the South Eastern Sydney area. A public awareness campaign, highlighting the need for bone densitometry in men and women 45 years and older who sustain minimal trauma fractures in order to diagnose osteoporosis, is required. Proven therapies for patients presenting with osteoporotic fractures, including men, are now available and should be considered.

Localization of nitric oxide synthases during fracture healing.

Previously, we have reported that nitric oxide synthases (NOSs), which generate NO, modulate fracture healing. However, the cellular sources of the NOS isoforms during the course of fracture healing have not been studied systematically. The purpose of this study was to localize the cellular distribution of NOS isoforms (inducible NOS [iNOS], endothelial NOS [eNOS], and neuronal NOS [bNOS]) by in situ hybridization and immunohistology after femoral fractures in rats.

A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears.

This prospective study was undertaken to compare the ability of clinical estimation, diagnostic ultrasonography, magnetic resonance imaging, and arthroscopy to estimate the size of rotator cuff tears. Estimates of rotator cuff tear size were compared with the findings at open operation in 33 consecutive patients with a presumptive diagnosis of rotator cuff tear. Arthroscopy estimates of rotator cuff tear size correlated best with actual tear size (Pearson correlation coefficient r = 0.

Clinical examination of the unstable shoulder.

The clinical history is usually a very helpful guide for identifying frank traumatic glenohumeral joint dislocations. Glenohumeral dislocation most commonly occurs in the anterior direction (>95%) with the shoulder forcibly abducted and externally rotated. Atraumatic, multidirectional and subtler glenohumeral instability are often harder to diagnose.

Reliability of 3 methods for assessing shoulder strength.

The reliability of tests for isometric strength of the shoulder joint in symptomatic subjects has yet to be established. For this purpose, interrater and intrarater agreement trials were undertaken to ascertain the reliability of manual muscle tests, a handheld dynamometer, and a spring-scale dynamometer for 5 different shoulder movements in symptomatic subjects. Intraclass correlation coefficients were calculated from a random-effects model.

Advances in the management of traumatic anterior and atraumatic multidirectional shoulder instability.

Dislocation of the shoulder is a common and often disabling injury to an athlete. Most shoulder dislocations are traumatic in origin, occur in the anterior direction and result in stretching and detachment of the anterior capsule and labrum. The most frequent adverse sequel of shoulder dislocation is recurrence--an event that occurs most commonly in active individuals and less frequently with age.

Shoulder instability. Diagnosis and management.

Background: The shoulder is the most commonly dislocated joint in the body. The most frequent complication of shoulder dislocation is recurrence, occurring most often in young athletes.

Objective: To summarise the functional anatomy of the shoulder joint, the structures damaged following shoulder dislocation and the methods to evaluate and treat shoulder instability.

Nitric oxide in skeletal muscle: inhibition of nitric oxide synthase inhibits walking speed in rats.

Nitric oxide (NO*) is a multifunctional messenger molecule generated by a family of enzymes called the nitric oxide synthases (NOSs). Although NOSs have been identified in skeletal muscle, specifically brain NOS (bNOS) and endothelial NOS (eNOS), their role has not been well clarified. The goals of this investigation were to (1) characterize the immunoreactivity, Ca(2+) dependence, and activity of NOS in human and rat skeletal muscle and (2) using a rat model, investigate the effect of chronic blockade of NOS on skeletal muscle structure and function.

Temporal expression of nitric oxide synthase isoforms in healing Achilles tendon.

We investigated the temporal expressions of the three nitric oxide synthase (NOS) isoforms by semi-quantitative polymerase chain reaction (PCR) assays and by immunoblot analysis, following Achilles tendon transection in rats. Four days after injury, there were increases in the steady-state levels of mRNA for all three NOS isoforms, with peaks for the inducible isoform (iNOS) (23-fold increase) at day 4, the endothelial isoform (eNOS) (24-fold increase) at day 7 and the neuronal isoform (bNOS) (seven-fold increase) at day 21. The temporal expression of NOS isoforms at a protein level was consistent with the results at the mRNA level.

The effects of time course after anterior cruciate ligament injury in correlation with meniscal and cartilage loss.

In this study, 130 consecutive patients with anterior cruciate ligament insufficiency who were undergoing ligament reconstruction underwent arthroscopic examination at the time of reconstruction, and any loss of meniscal or chondral integrity was documented in a systematic fashion. In these patients, a greater proportion of the medial meniscus was lost compared with the lateral meniscus (16% versus 5%). On average, 6 cm2 of the articular cartilage was damaged (5.

Nitric oxide regulates alkaline phosphatase activity in rat fracture callus explant cultures.

Nitric oxide (NO) is synthesised by a group of enzymes called nitric oxide synthases (NOS) and oxidizes to its stable end-products nitrite (NO2-) and nitrate (NO3-) We have previously reported in an in vivo rat model that NO is an important regulator for rat bone fracture healing. This study examines the effects of NO on alkaline phosphatase (ALP) activity in a rat fracture callus explant culture system. Explants of rat femoral fracture callus from days 4, 7, 14 and 28 post fracture induced NO2 release and ALP activity in a biphasic temporal manner, with the highest activity on day 7 and the lowest activity on day 14.

Nitric oxide modulates fracture healing.

The role of the messenger molecule nitric oxide has not been evaluated in fracture healing. NO is synthesized by three kinds of nitric oxide synthase (NOS): inducible NOS (iNOS), endothelial (eNOS), and neuronal (bNOS). We evaluated the role of these enzymes in a rat femur fracture-healing model.

The protective effects of meniscal transplantation on cartilage. An experimental study in sheep.

Background: Meniscal loss may result in arthritis. The aim of this study was to establish a simple operative method for meniscal transplantation in a large-animal model and to determine whether meniscal transplantation provides protection of the articular surfaces, whether meniscal allografts have the same protective effect as meniscal autogenous grafts, and whether there is any rejection phenomenon associated with meniscal allografts.

Methods: Twenty-eight sheep were divided into four study groups, which were treated with (1) a sham operation (four sheep), (2) a meniscectomy (eight sheep), (3) a meniscal autogenous graft (eight sheep), or (4) a meniscal allograft (eight sheep).

Heterogeneity in Klippel-Feil syndrome: a new classification.

Background: Klippel-Feil syndrome (KFS) is characterised by congenital vertebral fusion of the cervical spine and a wide spectrum of associated anomalies. KFS has often been considered a sporadic syndrome. However, since the publication of the original KFS classification early this century, a number of KFS families have indicated heterogeneity complicated by a broad range of variable expression.

Nitric oxide in arthritis.

Nitric oxide's (NO) involvement in arthritis was first demonstrated when levels of nitrite, a stable endproduct of NO metabolism, were shown to be elevated in serum and synovial fluid samples of rheumatoid and osteoarthritis patients. NO production by chondrocytes, its involvement in various biochemical events of cartilage metabolism, and the in vivo suppression of experimental arthritis by NO synthase inhibitors further implicated NO in arthritis. However, a conclusive role for NO in the pathogenesis of arthritis remains to be defined, in contrast to the NO-cGMP signal transduction pathway of endothelium-mediated vasodilation.