Physical Examination and Computed Tomography in Children with Toe in Gait

OBJECTIVE: To determine the correlation between the physical examination and the computed tomography of femoral anteversion and tibial internal torsion. METHOD: The angle of internal and external rotation of hip for femoral anteversion and thigh-foot angle for tibial internal torsion were measured by a rehabilitation physician for 116 young children with toe in gait. Within a week after the physical examination, the angle of femoral anteversion and tibial internal torsion were measured by computed tomography for comparison. RESULTS: Two-hundred thirty-two lower limbs of 116 children (64 girls and 52 boys) included in this study whose mean age was 6.4+/-2.7 years for girls and 6.8+/-2.8 years for boys. The Pearson correlation coefficient between the angle of internal rotation of the hip and the femoral anteversion measured by computed tomography showed 0.62 in right side and 0.55 in left side, an indication of significant correlation (p<0.01). The Pearson correlation coefficient between the thigh-foot angle and the tibial internal torsion measured by computed tomography showed 0.50 in right side, 0.42 in left side, an indication of significant correlation (p<0.01). CONCLUSION: Children with toe-in gauts showed a significant correlation between finding of physical exam (i.e. TFA and femoral internal torsion angle) and those of CT omages (i.e. tibial torsion angle and femoral torsion angle).

Atlantoaxial Subluxation in Undifferentiated Spondyloarthropathy: A case report

Atlantoaxial subluxation in undifferentiated spondyloarthropathy is extremely rare and has not been reported. We describe a case of 27-year-old man who was diagnosed as undifferentiated spondyloarthropathy with atlantoaxial subluxation with an initial complaint of painful swelling of right 1st metatarsophalangeal joint and posterior neck pain. Roentgenograms showed sclerotic change and increased hazziness in right 1st metatarsophalangeal joint. Magnetic resonance images and roentgenograms of the cervical spine showed inflammation of odontoid process and atlantoaxial subluxation. Bone scan showed hot uptakes in left sacroiliac joint, right 1st & 4th metacarpophalangeal joints and 1st metatarsophalangeal joint. HLA-B27 gene was positive. Spontaneous atlantoaxial subluxation and undifferentiated spondyloarthropathy was diagnosed and conservatively treated with oral medication. Currently, there is no definite neurological sign. Early recognition and awareness of potential clinical complications is important in preventing compressive damage on central nervous system.

The Success Rate of Superior Approach Glenohumeral Injection in Patients with Frozen Shoulder

OBJECTIVE: In treating patients with frozen shoulder, posterior and anterior approach glenohumeral injections are well known methods. But the accuracy of the above injection methods is low. In this study, we introduce the superior approach glenohumeral injection method and evaluate its success rate. METHOD: Twenty six patients who were clinically diagnosed with frozen shoulder were enrolled. Patients received a superior approach glenohumeral injection of 1 cc radiographic contrast (Urografin(R), Schering, Germany). The success of superior approach was determined by radiography study of the shoulder joint taken after the injection. RESULTS: 24 of the 26 procedures (92.3%) were judged to be accurately placed by the radiography study and there was no significant complication after the superior approach intrarticular injection. CONCLUSION: Superior approach glenohumeral injection in frozen shoulder showed the high success rate. We consider this superior approach as a very effective method. If the study for the interrater reliability is added, the superior approach will be considered to be a useful approach.

The Effect of Isoflavone on Bone Mineral Density and Maximum Load in Stroke Rat

OBJECTIVE: Because bone metabolic changes progress from initial stage of stoke, early prevention and treatment have been important. Isoflavone has been proved to be effective in post-menopausal osteoporosis. Therefore the authors used a stroke rat model and evaluated the effects of isoflavone on bone metabolism from initial stage of stroke. METHOD: Female Sprague-Dawley rats were randomly divided into 2 separate groups; a stroke without isoflavone supplement group and stroke with isoflavone supplement group. The bone mineral density (BMD) in 4th and 5th lumbar vertebrae were measured at the day before stroke, 11th and 18th days after the stroke. The BMD in excised distal femur and proximal tibia and the maximum load of emur neck and tibia shaft were measured at 18th days after the stroke. RESULTS: On the 18th day after stroke, BMD of stroke with isoflavone group was significantly higher than that of stroke without isoflavone group in 4th and 5th lumbar vertebrae and distal femur. The maximum load of stroke with isoflavone group was significantly higher than that of stroke without isoflavone group in femur neck. CONCLUSION: The results suggested that isoflavone supplement in stroke rat had beneficial effect on bone metabolism from the initial stage of stroke.

The Success Rate of Posterior Approach Glenohumeral Injection in Patients with Adhesive Capsulitis

OBJECTIVE: Accuracy of injection in patient with adhesive capsulitis may significantly affect the clinical outcome. The purpose of this study was to evaluate the success rate of posterior approach glenohumeral injection in patients with adhesive capsulitis. METHOD: Twenty-two patients who were clinically diagnosed with adhesive capsulitis were enrolled. They had sustained pain and limitation of motion in shoulder in spite of medication and physical therapy for at least 2 months and no history of trauma. Patients were received by a posterior approach glenohumeral injection of 2 ml radiographic contrast. Radiograph of the shoulder joint was taken immediately after the injection to determine success of the intra-articular injection. RESULTS: 5 of the 22 procedures (22.7%) were judged to be accurately placed and in the others the contrast media was observed in the muscular and subcutaneous tissues. CONCLUSION: This study showed that posterior approach glenohumeral injection in adhesive capsulitis was a difficult procedure. The low success rate of posterior approach glenohumeral injection in adhesive capsulitis would lead to repetitive injection and side-effect of corticosteroid. We consider fluoroscopy-guided intra-articular injection in adhesive capsulitis rather than posterior approach glenohumeral injection to increase the accuracy of intra-articular injection.