Prospective Evaluation of the Effectiveness of a Home-Based Program of Isometric Strengthening Exercises: 12-Month Follow-up

BACKGROUND: The aim of this prospective randomized clinical trial was to investigate the efficacy of a home-based program of isometric strengthening exercises for the treatment of the lateral epicondylitis (LE) of the distal humerus. We hypothesized that 1) use of isometric strengthening exercises would result in clinical benefits similar to those provided by medication and pain relief and 2) functional improvements after exercise would be time-dependent. METHODS: Patients were assigned to one of two groups: 1) an immediate physical therapy group (group I), or 2) a delayed physical therapy group (group D). Group I patients (n = 16) were instructed how to do the exercises at their first clinic visit and immediately carried out the exercise program. Group D patients (n = 15) learned and did the exercises after being on medications for 4 weeks. RESULTS: Outcomes at the 1-month clinic visit indicated that pain (measured using a visual analogue scale [VAS]) had been significantly reduced in group I compared to group D (p < 0.01). However, significant differences between groups were not found at 3-, 6-, and 12-month follow-up for either VAS scores or Mayo elbow performance scores. For modified Nirschl/Pettrone scores, a significant difference between groups was found only at the 1-month follow-up visit. By then, the number of participants who returned to all activities with no pain or occasional mild pain was six (37%) in Group I and two (13%) in Group D (p = 0.031). At the final follow-up visit, 88% of all participants performed physical activities without pain. CONCLUSIONS: Isometric strengthening exercises done early in the course of LE (within 4 weeks) provides a clinically significant improvement.

Open Intramedullary Nail with Tension Band Sutures & Lock Sutures on Proximal Humeral Three-part Fracture

PURPOSE: To evaluate the results according to the difference of age and bone mineral density (BMD) of the surgical treatments using open intramedullary nail with tension sutures and lock suture on proximal humeral three part fracture. MATERIALS AND METHODS: 30 patients treated by open intramedullary nail with tension band and lock suture technique on proximal humeral fractures were reviewed. After treatment, average follow up periods was 50 months (range; 17~143 month). Postoperative clinical outcome was evaluated using ASES functional score, Neer score and constant score. RESULTS: Bony union were obtained all except one case. Range of motion, mean forward elevation was 142°, mean external rotation was 56°, mean external rotation at 90° abduction was 68°. Average pain score of visual analog scale was 1.5. Average functional score of American Shoulder and Elbow Society was 86. Average Neer score was 89. Constant score was 85. Pain and functional score of group I were better than those of group, however, there was no statistically significant difference (p>0.05). In the comparison between group III and group IV, the results were same (p>0.05). CONCLUSION: The patients treated using open intramedullary nailing, tension band and lock suture could enable early ROM exercise and show good clinical results. This treatment method will be useful in old age osteoprorotic patients.

The Effect of Low Level Laser on the Fracture Healing in Guinea Pig Femur / 대한정형외과연구학회지

PURPOSE: This study was conducted to evaluate the effectiveness of the low level laser on the fracture-healing of the guinea pig femurs. MATERIALS AND METHODS: This study was performed on 36 guinea pigs(17 in the experimental group and 19 in the control group). After anesthesia of the guinea pigs, the shaft of femur was fractured with Gigli saw under aseptic conditions, and then the intramedullary nailing of K-wire was performed. The application of low level laser on the fracture sites in the experimental group began 2 days after the operation under anesthesia, for 30 minutes every 2 days. The laser we used was a CW-type microchip laser with output wave length of 890 nm and intensity of 13 mWatts, measuring upto 4.68 J/cm2 per each application. In order to compare the femur fracture healing process of both groups; gross findings, simple radiologic findings, and histologic findings of fracture site stability were evaluated. The simple radiologic and histologic findings were assessed by the scoring system invented by Zorlu and his colleagues. The statistical evaluation was done by using repeative measured ANOVA test. RESULTS: In both experimental and control groups, the gross findings progressed favorably. Although the improvement in radiologic findings were found in both groups with the passage of time, the experimental group showed a greater rate of callus formation with statistical significance(p<0.0) compared to the control group. The result of histological findings showed that a increase of osteoblastic proliferation was also greater in the experimental group(p<0.01). CONCLUSION: In this study, the low level laser was revealed to be effective on acceleration of femur fracture healing in guinea pigs.

Shoulder Impingement Syndrome Combined with Myofascial Pain Syndrome / 대한정형외과학회잡지

PURPOSE: In order to study the frequency and the site of pain with shoulder impingement syndrome accompanied by myofascial pain syndrome (MPS), and to see how the treatment of impingement syndrome effects the improvement in myofascial pain. MATERIALS AND METHODS: Among patients diagnosed with shoulder impingement syndrome with MPS and who complained around of shoulder muscle pain 53 subjects were selected as subjects for this study. Patients were divided into three groups according to method of treatment; the first group was the cases who received impingement injection test, the second group were only carried out isometric strengthening exercise of the periscapular muscles and the rotator cuff, and the third group was the cases who failed conservative treatment and had a surgical operation. All subjects had a physical examination before treatment to see if the MPS was present in the muscles around the shoulder, the range of motion of shoulder, and the American Shoulder and Elbow Society (ASES) shoulder score were measured. RESULTS: There was no relation to between age, gender, impingement signs, tenderness around the joints, the range of motion and ASES shoulder score. The VAS was reduced from 6.2+/-2.3 to 1.2+/-1.5 (p0.05). CONCLUSION: Treatment of shoulder impingement syndrome reduced the symptoms of MPS, thus shoulder impingement syndrome can be the one of the causes of MPS.