Factores asociados con rigidez de las articulaciones del hombro y la cadera en adultos mayores / Factors associated with stiffness of the shoulder and hips joints in the elderly

Introducción: mantener el nivel adecuado de flexibilidad en la edad adulta es importante para realizar las actividades básicas de la vida diaria; sin embargo, esta puede verse afectada negativamente por distintos factores, como el sedentarismo, la artrosis, la diabetes y el estado emocional. Objetivo: analizar la prevalencia de la rigidez en las articulaciones del hombro y coxofemoral, con factores asociados en los adultos mayores de la ciudad de Cuenca, Ecuador. Metodología: estudio analítico transversal con una muestra de 160 adultos mayores de las residencias geriátricas de la ciudad de Cuenca, Ecuador. La información se recolectó aplicando dos tests que valoran la flexibilidad, incluidos en la batería Senior fitness test (SFT): el Back scratch (TBS) y el test Chair sit and reach (TCSAR), para valorar el grado de rigidez de las articulaciones del hombro y coxofemoral. El nivel de actividad física se evaluó utilizando el test Rapid Assessment of Physical Activity (RAPA), y se utilizaron el test Yesavege para valorar el grado de depresión y la historia clínica de cada paciente, para conocer antecedentes de diabetes mellitus o artrosis. Se analizaron los datos con el programa SPSS versión 20.0®, por medio de medidas de frecuencia, dispersión, análisis bivariado (OR, IC, valor P). Resultados: se evidenció la inactividad física como factor de riesgo importante para padecer rigidez de articulación del hombro p=0,023, articulación coxofemoral p<0,001; además, la artrosis como factor de riesgo para rigidez en miembros superiores. La pre-valencia de rigidez articular fue de 40,6% en miembros inferiores y el 70,6%en los miembros superiores. Conclusión: los hallazgos de esta investigación corroboran que la inactividad física pue-de llevar a la pérdida progresiva de la flexibilidad en adultos mayores, con disminución en el rango de movimiento articular y limitación funcional. (AU)

Introduction: maintaining the appropriate level of flexibility in adulthood is important to carry out the basic activities of daily life; however, this can be negatively affected by different factors, such as a sedentary lifestyle, osteoarthritis, diabetes and emotional state. Objective: to analyze the prevalence of stiffness in the shoulder and coxofemoral joints, with associated factors in older adults in the city of Cuenca, Ecuador. Methodology: cross-sectional analytical study with a sample of 160 older adults from nursing homes in the city of Cuenca. The information was collected by applying two tests that assess flexibility, included in the senior fitness test (SFT) battery: the back scratch (TBS) and the chair sit and reach test (TCSAR), to assess the degree of stiffness of the knee joint. shoulder and coxofemoral. The level of physical activity was evaluated using the Rapid Assessment of Physical Activity (RAPA) test, the Yesavege test was used to assess the degree of depression and the clinical history of each patient to determine a history of diabetes mellitus or osteoarthritis. The data were analyzed with the SPSS version 20.0 program, through measures of frequency, dispersion, and bivariate analysis (OR, CI, P value). Results: physical inactivity was evidenced as an important risk factor for shoulder joint stiffness p=0.023, coxofemoral joint p=<0.001; in addition, osteoarthritis as a risk factor for stiffness in the upper limbs. The prevalence of joint stiffness was 40.6% in the lower limbs and 70.6% in the upper limbs. Conclusion: the findings of this research corroborate that physical inactivity can lead to progressive loss of flexibility in older adults, with decreased range of joint movement and functional limitation. (AU)

Risk factors for radiological hip involvement in patients with ankylosing spondylitis

SUMMARY OBJECTIVE: Our study aimed to explore the potential risk factors for radiological hip joint involvement in patients with ankylosing spondylitis (AS). METHODS: This cross-sectional convey collected the clinical data, laboratory indicators, and radiographic data of patients with AS. Radiographic hip joint involvement was defined as a Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) score ≥2. Multivariate logistic regression analyses were conducted to explore the potential risk factors for radiological hip involvement in patients with AS. RESULTS: Based on BASRI-hip score, all enrolled 386 patients with AS were classified as patients involving with radiological hip joint involvement (BASRI-hip ≥2; n=203) and those without it (BASRI-hip ≤1; n=183). Mean age of enrolled patients with AS were 36.7±11.9 years, and 320 (82.9%) patients were male. Mean course of disease was 10.7±8.3 years, and 349 (90.4%) patients were with a positive HLAB27. Multivariate analyses indicated that Juvenile onset (onset age ≤16 years) (odds ratio [OR]=4.159, 95% confidence interval [CI], 1.779-9.721, p<0.001), body mass index (BMI) <18.5 kg/m2 (OR=1.986, 95%CI 1.187-3.323, p=0.009), continuous nonsteroidal anti-inflammatory drug (NSAID) use (OR=0.351, 95%CI 0.155-0.794, p=0.012), and bone mass below the expected range for age (Z score ≤-2) (OR=2.791, 95%CI 1.456-5.352, p=0.002) were independently associated with radiological hip joint involvement in patients with AS. CONCLUSIONS: The potential risk factors for radiological hip joint involvement were juvenile onset, lower BMI, and bone mass below the expected range for age. Furthermore, continuous NSAID use was the protective factor for radiological hip joint involvement in these population.

Brucella melitensis es un agente de la artritis pediatrica: Serie de casos / Brucella melitensis is an agent in pediatric arthritis: Case series

La brucelosis es un importante problema de salud y, en algunas regiones, es endémica. En ella, es muy frecuente observar un compromiso osteoarticular (20%-60%). En regiones donde es endémica, al analizar la etiología de la artritis, hay que pensar en esta entidad. En este artículo, se informan los casos de 12 pacientes; 11 de ellos eran varones, y la media de edad fue de 12 años (intervalo: de 2 a 17 años). Se determinó el compromiso de la cadera en 9 pacientes; de la articulación sacroilíaca, en 2; y de la rodilla, en 1. Todos los pacientes tenían artralgia; 8 pacientes tuvieron fiebre; y 1 paciente, leucocitosis. A un paciente se lo sometió a un tratamiento quirúrgico debido a artritis séptica. La infección puede derivar en complicaciones graves, especialmente en el compromiso del aparato locomotor. Debe tenerse en cuenta que, mediante el diagnóstico y tratamiento tempranos, es posible prevenir las complicaciones.

Brucellosis is a significant health problem and is endemic in some regions. Osteoarticular involvement is seen most frequently in brucellosis (20-60%). In regions where brucellosis is endemic, it should be considered in the etiology of arthritis. We report the 12 cases, were 11 males with a mean age of 12 years (range, 2-17 years). Involvement was determined in the hip in 9 cases, the sacroiliac joint in 2 and the knee in 1. All the cases had arthralgia, fever was determined in 8 cases and leukocytosis in one case. Surgical treatment was applied to one case because of septic arthritis. Serious complications of the infection may be encountered and particularly in musculoskeletal system involvement, it should be kept in mind that complications can be prevented by early diagnosis and treatment

WOMAC and SF-36: instruments for evaluating the health-related quality of life of elderly people with total hip arthroplasty. A descriptive study / WOMAC e SF-36: instrumentos para avaliar a qualidade de vida relacionada à saúde de idosos com artroplastia total de quadril. Um estudo descritivo

CONTEXT AND OBJECTIVES: Quality-of-life results have increasingly been evaluated among patients undergoing joint replacements. The objective of this study was to compare two assessment instruments for health-related quality of life (one generic and the other specific), among elderly patients undergoing total hip arthroplasty.DESIGN AND SETTING: Cross-sectional descriptive study in a reference hospital in the region of Campinas.METHODS: The subjects were 88 elderly outpatients aged 60 years or over who underwent primary total hip arthroplasty. Two instruments for assessing health-related quality of life were applied: the generic Medical Study 36-item Short-Form Health Survey (SF-36) and the specific Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Cronbach's alpha and the ceiling and floor effects of the instruments were evaluated.RESULTS: The scores from both instruments showed that issues of a physical nature affected these elderly people's quality of life most. The pain and stiffness dimensions of WOMAC showed ceiling effects and only the functional capacity and pain dimensions of the SF-36 did not show the ceiling effect. The SF-36 presented floor effects in the dimensions of physical and emotional aspects. Cronbach's alpha was considered satisfactory in both instruments (α > 0.70).CONCLUSIONS: The floor and ceiling effects that were observed suggest that these instruments may present some limitations in detecting changes to the majority of the SF-36 dimensions, except for functional capacity and pain, and to the pain and stiffness dimensions of WOMAC, when applied to elderly people with total hip arthroplasty.

CONTEXTO E OBJETIVO: Os resultados sobre a qualidade de vida têm sido cada vez mais avaliados em pacientes submetidos a substituições articulares. Este estudo objetivou comparar dois instrumentos de avaliação de qualidade de vida relacionada à saúde (um genérico e outro específico), em pacientes idosos submetidos a artroplastia total de quadril.TIPO DE ESTUDO E LOCAL: Estudo descritivo transversal em hospital de referência da região de Campinas.MÉTODOS: Os sujeitos foram 88 pacientes idosos ambulatoriais, com 60 anos ou mais, submetidos a artroplastia total de quadril primária. Foram aplicados dois instrumentos de avaliação de qualidade de vida relacionada à saúde: Medical Study 36-item Short-Form Health Survey (SF-36) (genérico) e Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (específico). O coeficiente alfa de Cronbach e os efeitos teto e chão dos instrumentos foram avaliados.RESULTADOS: Os escores de ambos os instrumentos mostraram que as questões de natureza física são as que mais afetam a qualidade de vida desses idosos. As dimensões dor e rigidez do WOMAC apresentaram efeito teto e apenas as dimensões capacidade funcional e dor do SF- 36 não mostraram o efeito teto. O SF-36 apresentou efeito de chão nas dimensões: aspectos físicos e aspectos emocionais. O coeficiente alfa de Cronbach foi considerado satisfatório nos dois instrumentos (α > 0.70).CONCLUSÕES: A constatação dos efeitos chão e teto sugere que esses instrumentos podem apresentar algumas limitações, quando aplicados em idosos com artroplastia total de quadril, para detectar alterações na maioria das dimensões do SF-36, exceto capacidade funcional e dor, e nas dimensões dor e rigidez do WOMAC.

Hallazgos ecográficos de la articulación coxofemoral y su correlación con la actividad de la enfermedad y hallazgos clínicos en artritis reumatoide / Sonographic findings of the joint coxofemoral and correlation with disease activity and clinical findings in rheumatoid arthritis

To describe the sonographic findings of the hip joint in patients with rheumatoid arthritis and to assess their correlation with signs and symptoms of disease activity (pain, range of motion, overall disease activity). Methods: We performed an observational, cross-sectional and analytical study. Patients aged 18 60 years of age diagnosed with rheumatoid arthritis were included. We did not include patients with hip prostheses or hip infiltration in the previous 3 months. We performed an ultrasound examination (7-12 MHz linear transducer) of both hips and recorded demographic, clinical, ultrasonographic and goniometric findings (flexion, extension, abduction, adduction, internal and external rotation). Results: We evaluated 102 hips of 51 patients (37 women) aged 43.5 +/- 9.4 years, body mass index (BMI): 26.4 +/- 5.18, disease duration: 117 +/- 107 months, DAS28: 4.08 +/- 1.58, hip pain history: 20 (39.2 percent), concurrent hip pain 3 (5.8 percent), use of DMARDs: 47 (92.1 percent), biological therapy 8 (15.68 percent), comorbidity: 25 (50.1 percent), positive rheumatoid factor: 43 (84.3 percent) and evocation of pain: 28 (54.9 percent). Ultrasound findings: Osteophytes: 52 (50.9 percent), cartilage injury: 47 (46.0 percent), trochanteric enthesopathy: 33 (32.3 percent), effusion: 14 (13.7 percent), erosions: 6 (5.8 percent), synovial hypertrophy: 5 (4.9 percent) and iliopsoas bursitis 2 (1.9 percent). There was no correlation of ultrasound with DAS28 or laboratory parameters. Evoking pain correlated with the presence of effusion (p = 0.038). Conclusions: The major ultrasound abnormalities were osteophytes, articular cartilage injury and trochanteric enthesopathy. According to our findings is advisable to include hip in the clinical assessment and initial and subsequent ultrasound evaluation of patients with rheumatoid arthritis...

Describir los hallazgos ecográficos de la articulación coxofemoral en pacientes con artritis reumatoide y evaluar su correlación con los signos y síntomas de actividad de la enfermedad (dolor, rango de movimiento, actividad global de la enfermedad). Material y métodos: Es un estudio observacional, transversal y analítico. Se incluyeron pacientes de 18 a 60 años de edad con diagnóstico de artritis reumatoide. No se incluyeron pacientes con prótesis de cadera o infiltración de la cadera en los tres meses previos. Se realizó ecografía (transductor lineal 7-12 MHz) de ambas caderas y se registraron datos demográficos, clínicos, ecográficos y goniométricos (flexión, extensión, abducción, aducción, rotación interna y externa). Resultados: Se evaluaron 102 caderas de 51 pacientes (37 mujeres) con edad de 43,5 +/- 9,4 años, índice de masa corporal (IMC): 26,4 +/- 5,18, evolución de la enfermedad: 117 +/- 107 meses, DAS28: 4,08 +/- 1,58, historia de dolor: 20 (39,2 por ciento), dolor concurrente: 3 (5,8 por ciento), uso de FARME: 47 (92,1 por ciento), terapia biológica: 8 (15,68 por ciento), comorbilidad: 25 (50,1 por ciento), factor reumatoide positivo: 43 (84,3 por ciento) y evocación de dolor: 28 (54,9 por ciento). Hallazgos ecográficos: Osteofitos: 52 (50,9 por ciento), lesión de cartílago: 47 (46,0 por ciento), entesopatía trocantérica: 33(32,3 por ciento), derrame: 14 (13,7 por ciento), erosiones: 6 (5,8 por ciento), hipertrofia sinovial: 5 (4,9 por ciento) y bursitis iliopsoas: 2 (1,9 por ciento). No se encontró correlación de la ecografía con el DAS28 ni con los parámetros de laboratorio. La evocación de dolor se correlacionó con la presencia de derrame (p = 0,038).Conclusiones: Las principales alteraciones ecográficas fueron osteofitos, lesión del cartílago articular y entesopatía trocantérica. De acuerdo a nuestros hallazgos, es recomendable incluir a la cadera en la valoración clínica y ecográfica inicial y subsecuente de los...

Translation, cross-cultural adaptation and validation of the Brazilian version of the Nonarthritic Hip Score / Traducao, adaptacao cultural e validacao da versao brasileira do questionario Nonarthritic Hip Score

CONTEXT AND OBJECTIVE The Nonarthritic Hip Score (NAHS) is a clinical evaluation questionnaire that was developed in the English language to evaluate hip function in young and physically active patients. The aims of this study were to translate this questionnaire into the Brazilian Portuguese language, to adapt it to Brazilian culture and to validate it. DESIGN AND SETTING Cohort study conducted between 2008 and 2010, at Universidade do Estado do Rio de Janeiro (UERJ). METHODS Questions about physical activities and household chores were modified to better fit Brazilian culture. Reproducibility, internal consistency and validity (correlations with the Algofunctional Lequesne Index and the Western Ontario and McMaster Universities Arthritis Index [WOMAC]) were tested. The NAHS-Brazil, Lequesne and WOMAC questionnaires were applied to 64 young and physically active patients (mean age, 40.9 years; 31 women). RESULTS The intraclass correlation coefficient (which measures reproducibility) was 0.837 (P < 0.001). Bland-Altman plots revealed a mean error in the difference between the two measurements of 0.42. The internal consistency was confirmed through a Cronbach alpha of 0.944. The validity between NAHS-Brazil and Lequesne and between NAHS-Brazil and WOMAC showed high correlations, r = 0.7340 and r = 0.9073, respectively. NAHS-Brazil showed good validity with no floor or ceiling effects. CONCLUSION The NAHS was translated into the Brazilian Portuguese language and was cross-culturally adapted to Brazilian culture. It was shown to be a useful tool in clinical practice for assessing the quality of life of young and physically active patients with hip pain. .

CONTEXTO E OBJETIVO O Nonarthritic Hip Score (NAHS) é um questionário de avaliação clínica que foi desenvolvido na língua inglesa para avaliar a função do quadril em pacientes jovens e fisicamente ativos. O objetivo desse estudo foi traduzir o questionário NAHS para a língua portuguesa do Brasil, adaptá-lo à cultura brasileira e validá-lo. TIPO DE ESTUDO E LOCAL Estudo de coorte, realizado entre 2008 e 2010, na Universidade do Estado do Rio de Janeiro (UERJ). MÉTODOS Questões sobre atividades físicas e tarefas domésticas foram modificadas para melhor adaptação à cultura brasileira. Reprodutibilidade, consistência interna e validade (correlação entre o Algofunctional Lequesne Index e o Western Ontario McMaster Universities Arthritis Index [WOMAC]) foram testadas. Os questionários NAHS-Brasil, Lequesne e WOMAC foram aplicados em 64 pacientes jovens e fisicamente ativos (média de idade, 40,9 anos; 31 mulheres). RESULTADOS O coeficiente de correlação intraclasse que avalia reprodutibilidade mostrou valores de 0,837 (P < 0,001). O gráfico de Bland-Altman revelou um erro médio da diferença das duas medidas de 0,42. A consistência interna foi avaliada pelo alfa de Cronbach com valores de 0,944. A validade entre os questionários NAHS-Brasil/Lequesne e NAHS-Brasil/WOMAC mostraram alta correlação, r = 0,7340 e r = 0,9073; respectivamente. O NAHS-Brasil mostrou boa validade sem efeitos de chão ou de teto. CONCLUSÃO O NAHS foi traduzido para a língua portuguesa do Brasil e adaptado para a cultura brasileira, mostrando ser uma ferramenta útil na prática clínica para avaliar a qualidade de vida de pacientes jovens e fisicamente ativos com dor no quadril. .

Diabetic patients with and without peripheral neuropathy reveal different hip and ankle biomechanical strategies during stair descent / Pacientes diabéticos com e sem a neuropatia periférica mostram diferentes estratégias biomecânicas de quadril e tornozelo ao descer escada

BACKGROUND: The progression of diabetes and the challenge of daily tasks may result in changes in biomechanical strategies. Descending stairs is a common task that patients have to deal with, however it still has not been properly studied in this population. OBJECTIVES: We describe and compare the net joint moments and kinematics of the lower limbs in diabetic individuals with and without peripheral neuropathy and healthy controls during stair descent. METHOD: Forty-two adults were assessed: control group (13), diabetic group (14), and neuropathic diabetic group (15). The flexor and extensor net moment peaks and joint angles of the hip, knee, and ankle were described and compared in terms of effect size and ANOVAs (p<0.05). RESULTS: Both diabetic groups presented greater dorsiflexion [large effect size] and a smaller hip extensor moment [large effect size] in the weight acceptance phase. In the propulsion phase, diabetics with and without neuropathy showed a greater hip flexor moment [large effect size] and smaller ankle extension [large effect size]. CONCLUSION: Diabetic patients, even without neuropathy, revealed poor eccentric control in the weight acceptance phase, and in the propulsion phase, they showed a different hip strategy, where they chose to take the leg off the ground using more flexion torque at the hip instead of using a proper ankle extension function.

CONTEXTUALIZAÇÃO: A progressão do Diabetes Mellito e as atividades desafiadoras do dia a dia podem resultar em mudanças da estratégia biomecânica adotada. Descer escadas é uma tarefa comum do dia a dia, vivenciada pelos pacientes, mas ainda não foi satisfatoriamente estudada nessa população. OBJECTIVOS: Descrever e comparar os momentos articulares e a cinemática de membros inferiores em indivíduos diabéticos com e sem a neuropatia periférica e controles saudáveis durante o descer escadas. MÉTODO: Quarenta e dois adultos foram avaliados: grupo controle (13), grupo diabético (15) e grupo de diabéticos neuropatas (14). Os picos flexores e extensores dos momentos articulares e os ângulos articulares de quadril, joelho e tornozelo foram comparados e descritos por análise do tamanho do efeito e ANOVAs (p<0,05). RESULTADOS: Na fase de aceitação do peso, ambos os grupos diabéticos apresentaram maior ângulo de dorsiflexão de tornozelo [tamanho de efeito grande] e menor momento extensor de quadril [tamanho de efeito grande]. Na fase de propulsão, diabéticos com e sem a neuropatia apresentaram maior momento flexor de quadril [tamanho de efeito grande] e menor ângulo de extensão de tornozelo [tamanho de efeito grande]. CONCLUSÃO: Pacientes diabéticos, mesmo antes da neuropatia instalada, revelaram um pobre controle excêntrico na fase de aceitação do peso e, na fase de propulsão, esses pacientes mostraram uma estratégia diferente ao levar o membro inferior à frente a partir de um maior torque flexor de quadril ao invés de usar uma função extensora apropriada de tornozelo.

Relação entre rigidez articular passiva e torque concêntrico dos rotadores laterais do quadril / Relationship between joint passive stiffness and hip lateral rotator concentric torque

CONTEXTUALIZAÇÃO: Rigidez passiva adequada do quadril pode impedir movimentos excessivos dos membros inferiores no plano transverso durante a realização de atividades funcionais. O fortalecimento muscular dos rotadores laterais do quadril poderia ser utilizado na tentativa de aumentar a rigidez dessa articulação. No entanto, a relação entre rigidez passiva e força dos músculos do quadril não está documentada na literatura. OBJETIVO: Investigar a associação entre rigidez passiva do quadril durante o movimento de rotação medial e torque concêntrico dos rotadores laterais dessa articulação em indivíduos saudáveis. MÉTODO: Foram avaliados 26 indivíduos com média de idade de 24,42±2,77 anos. Para quantificação da rigidez passiva do quadril, o torque passivo de resistência durante a rotação medial dessa articulação foi mensurado por um dinamômetro isocinético. A rigidez foi determinada como a inclinação média da curva de torque passivo obtida nos primeiros 20° do movimento. Eletromiografia foi utilizada para verificar o repouso dos músculos do quadril durante esse procedimento. O dinamômetro isocinético também foi utilizado para avaliação do pico de torque e trabalho máximo dos rotadores laterais do quadril em uma amplitude de 55° de rotação. RESULTADOS: Regressões lineares demonstraram coeficientes de correlação r=0,70 (R²=0,50/p<0,001) e r=0,77 (R²=0,59/p<0,001) entre rigidez do quadril e as medidas de pico de torque e trabalho muscular dos rotadores laterais, respectivamente. CONCLUSÕES: Existe associação de moderada a boa entre rigidez passiva do quadril e torque concêntrico dos rotadores laterais dessa articulação. A associação demonstrada sugere que o fortalecimento dos rotadores laterais pode ser eficaz em aumentar a rigidez do quadril.

BACKGROUND: Adequate passive stiffness of the hip joint can prevent the occurrence of excessive transverse plane lower limb movement during functional activities. Strength training of the hip lateral rotator muscles can be used to increase the stiffness of this joint. However, the relationship between hip joint passive stiffness and muscle strength remains undocumented in the literature. OBJECTIVE: To investigate the association between hip passive stiffness measured during medial rotation and hip lateral rotator concentric torque in healthy young adults. METHOD: Twenty-six individuals with mean age of 24.42±2.77 years participated in the present study. To quantify hip stiffness, the passive resistance torque during medial rotation was measured using an isokinetic dynamometer. Stiffness was determined by the mean slope of the passive torque curve obtained in the first 20° of motion. Electromyography was used to ensure inactivity of the hip muscles during this procedure. The isokinetic dynamometer was also used for assessment of hip lateral rotator peak torque and work in a range of motion of 55° of rotation. RESULTS: Linear regressions demonstrated correlation coefficients of r=0.70 (R²=0.50/p<0.001) and r=0.77 (R²=0.59/p<0.001) between hip passive stiffness and the measures of lateral rotator peak torque and work, respectively. Conclusions: There is a moderate to good association between hip passive stiffness and lateral rotator concentric torque. This association suggests that lateral rotator strength training can increase hip stiffness.

Gait analysis of patients with metal-on-metal resurfacing hip arthroplasty compared with big-femoral-head total hip arthroplasty

To evaluate gait patterns in patients with metal-on-metal resurfacing hip arthroplasty [RHA] compared with big-femoral-head total hip arthroplasty [BHA] at one year postoperatively. In this retrospective comparative observational study, 2 groups of 30 resurfacing hip arthroplasty [RHA] and big-femoral-head total hip arthroplasty [BHA] patients participated between June 2006 and March 2009 in the Sixth Affiliated People's Hospital, Shanghai Jiaotong University, Shanghai, China. Gait parameters and range of motion [ROM] in gait cycles were measured by Vicon gait analysis system and were used to calculate operated/contralateral ratios. No significant difference was found between gait parameter ratios, Hospital for Special Surgery Score [HSS], and University of California at Los Angeles Score [UCLA] of the 2 groups. However, there was significant difference between ROM ratios in gait cycles. Range of motions of operated hip joint were more similar to that of contra-lateral side in RHA group [hip flexion/extension p=0.007, hip abduction/adductionp=0.005, hip rotation p=0.006, knee flexion/extension p=0.037]. Gait parameters of patients who underwent RHA and BHA are approaching to normal values at one year postoperatively. At the time point, ROMs of RHA patients are larger than that of BHA patients during walking

Análise do uso de suporte parcial de peso corporal em esteira e em piso fixo durante o andar de crianças com paralisia cerebral / Analysis of partial body weight support during treadmill and overground walking of children with cerebral palsy

OBJETIVO: Analisar características espaço-temporais e ângulos articulares de crianças com paralisia cerebral andando sem o uso de suporte parcial de peso corporal (SPPC) em piso fixo e com 0 por cento e 30 por cento de SPPC em piso fixo e em esteira. MÉTODOS: Seis crianças com paralisia cerebral hemiplégica espástica (7,70±1,04 anos) foram filmadas andando com velocidade confortável sem o uso de SPPC, com 0 por cento e 30 por cento de SPPC em piso fixo e com 0 por cento e 30 por cento de SPPC em esteira. Marcadores refletivos foram afixados nos principais pontos anatômicos dos dois hemicorpos para registro das coordenadas "x", "y", "z". RESULTADOS: As crianças andaram mais rapidamente e com passadas mais longas e mais rápidas, com duração dos períodos de apoio simples e balanço maiores e apoio duplo menor no piso fixo do que na esteira, independentemente do uso do SPPC. O quadril foi a única articulação que apresentou diferenças entre os hemicorpos e entre as condições, sendo que o hemicorpo plégico apresentou menor amplitude de movimento (ADM) que o hemicorpo não plégico, e a ADM foi maior na condição sem o uso de SPPC do que com 30 por cento de SPPC em piso fixo. CONCLUSÃO: Crianças com paralisia cerebral hemiplégica espástica são capazes de andar em piso fixo e esteira com diferentes porcentagens de SPPC, sendo que seus desempenhos foram melhores no piso fixo, independentemente do uso de SPPC, do que na esteira.

OBJECTIVE: To analyze the spatial-temporal characteristics and joint angles during overground walking without body weight support (BWS) and with 0 percent and 30 percent BWS, and during treadmill walking with the same BWS in children with cerebral palsy. METHODS: Six children with hemiplegic and spastic cerebral palsy (7.70 ± 1.04 years old) were videotaped during overground walking at a comfortable speed with no BWS, with 0 percent and 30 percent BWS, and during treadmill walking with 0 percent and 30 percent BWS. Reflective markers were placed over main bony landmarks in both body sides to register the coordinates "x", "y", "z". RESULTS: During overground walking, children walked faster and presented longer and faster strides, longer duration of single-stance and swing periods, and shorter duration of double-stance period, than treadmill walking, regardless of BWS use. The hip was the only joint that presented a difference between body sides and experimental conditions; i.e. range of motion (ROM) was reduced in the plegic side when compared to the nonplegic side, and during overground walking without BWS when compared to 30 percent BWS. CONCLUSION: Children with hemiplegic and spastic cerebral palsy were able to walk overground and on a treadmill with different percentages of BWS, and their performance was superior during overground walking, regardless of BWS use.

Effect of serial casting in spastic cerebral palsy.

OBJECTIVE: Cerebral palsy (CP) is a range of non progressive syndromes of posture and motor impairment due to an insult to developing brain. Spasticity and incoordination are major causes of disability in these children which can be managed by different modalities like casting, botulinum toxin, surgery etc. Cast application in spastic equinus is a well established procedure in CP but cast application in patients of CP with bilateral involvement of hip, knee and ankle is not document. METHODS: A study was conducted on 22 children of spastic CP in age range of 3-8 years with bilateral involvement of hip, knee and ankle in 20 cases, hip and ankle in one case and only ankle in one case. Sixty eight % children were spastic diplegics. Serial weekly cast with (11 cases) or without abductor bar (11 cases) was applied for four weeks. They were followed up variably with an average period of 7 months. RESULTS: Significant improvement was noticed in range of motion around hip, knee and ankle which as maintained over hip and knee after average follow up. Spasticity was also reduced as measured by Modified Ashworth Scale (MAS). This ultimately improved the ambulatory status and functional ability of these children. CONCLUSION: Thus serial casting is a very simple, safe and cost effective procedure which can be applied even in children with mental sub normality having all three major joints involved bilaterally.

Efeito transiente de exercícios de flexibilidade na articulação do quadril sobre a marcha de idosas / Transient effect of flexibility exercises in the hip joint on the gait of older women

A marcha é a atividade mais comum que o ser humano realiza, sendo uma habilidade motora fundamental para a locomoção. Contudo, o processo do envelhecimento é caracterizado pela redução gradativa da eficiência do aparelho locomotor, que ocorre pela diminuição da força e da massa muscular, assim como diminuição na flexibilidade. O estudo objetivou verificar o efeito transiente de uma sessão de exercícios de flexibilidade dos músculos extensores e flexores do quadril sobre a marcha de indivíduos idosos. Cinco idosas (67,0 ± 3,8 anos; 1,59 ± 0,07 m; 64,3 ± 15,3 Kg) voluntariaram participar do estudo. A marcha dos sujeitos foi analisada antes e depois dos exercícios de flexibilidade. O protocolo consistiu em uma sessão de três séries de exercícios de flexibilidade de 30s do método estático, feitos para os músculos flexores e extensores da articulação do quadril. Após a sessão de flexibilidade, a marcha das participantes apresentou menor pico de inclinação anterior da pelve, maior pico de extensão e amplitude total de movimento da articulação do quadril, maior amplitude de movimento do joelho com maior ângulo de flexão durante a fase de balanço médio e maior altura de separação do pé ao solo (aumento esse de 28,6 por cento). Os resultados mostram que imediatamente após a sessão dos exercícios de flexibilidade as mulheres idosas apresentaram mudanças no padrão da marcha nos quais algumas variáveis sugerem uma redução no risco de quedas. Os efeitos da idade sobre determinadas variáveis foram parcialmente revertidos e as participantes apresentaram um padrão da marcha mais similar aos adultos jovens que antes dos alongamentos.

Gait is the most common activity performed by humans, being a fundamental motor ability to locomotion. However, ageing is characterized by a gradual reduction of the locomotor apparatus efficiency which occurs by the decrease in strength, muscle mass and flexibility. This study aimed to verify the transient effect of a single session of hip extensor and flexor muscles stretching exercises over gait in elderly subjects. Five elderly ladies (67.0 ± 3.8 years 1.59 ± 0.07 m; 64.3 ± 15.3 Kg) volunteered to participate in the study. Gait analysis was performed before and after stretching exercises. The stretching protocol was applied in a single session and consisted of three static stretching exercises conducted during 30s for the hip joint flexor and extensor muscles. After the stretching session, participants' gait showed reduced pelvic anterior tilt peak, greater hip range of motion and extension peak, greater knee range of motion, greater knee peak flexion angle during the mid swing and greater toe clearance (28.6 percent). Results showed that immediately after a stretching session, the elderly women presented alterations in the gait pattern in which some variables suggest a reduced risk of fall. The effects of ageing over some variables were partially reversed and the participants presented a gait pattern more similar to young adults than before stretching.

Asymptomatic avascular osteonecrosis of the hip in new patients diagnosed as systemic lupus erythematosus in Ramathibodi Hospital.

OBJECTIVE: To determine asymptomatic avascular osteonecrosis (AVN) of the hip in new patients diagnosed as Systemic Lupus Erythematosus (SLE) in Ramathibodi Hospital. MATERIAL AND METHOD: A prospective descriptive study of new SLE patients with asymptomatic hip at the Rheumatology clinic of Ramathobodi Hospital was conducted from February 2005 to November 2005. The information of steroid and immunosuppressive drug treatment was recorded Plain film (AP and frog leg views) and MR study of both hips were analyzed. RESULTS: Twenty-two hips (II patients) were enrolled in the present study (women 100%; mean age 27.8 years; range 16-50). Four hips (2 patients, 18%) had A VN, without other abnormal imaging findigs of the hips and pelvis. Seventeen hips of nine patients hadjoint effusion; none of them had AVN. No marrow edema, secondary osteoarthritis, collapsed femoral head or pelvic insufficiency fracture in allpatients is detected. In the present study, the 2 AVN patients had longest duration of steroid treatment before MR study (105 & 99 days) and rather high cumulative dose of prednisolone or its equivalent dose (4920 & 4540 mg), compared to non-AVN patients. CONCLUSION: SLE patients without hip pain may have AVN of the hips. Joint effusion and marrow edema do not necessarily associate with early AVN, and the authors found early AVN without joint effusion. Cumulative dose and duration of steroid treatment seem to relate to AVN in the present study. However a larger number of cases, prospective clinical data, and long-term follow up will help better evaluate the prevalence of asymptomatic AVN of the hips, as well as to evaluate the benefit of MRI as a screening tool for patients at risk of AVN.

Changes in joint kinematics in children with cerebral palsy while walking with and without a floor reaction ankle-foot orthosis

INTRODUCTION: The floor reaction ankle-foot orthosis is commonly prescribed in the attempt to decrease knee flexion during the stance phase in the cerebral palsy (CP) gait. Reported information about this type of orthosis is insufficient. PURPOSE: The purpose of this study was to determine the effect of clinically prescribed floor reaction ankle-foot orthosis on kinematic parameters of the hip, knee and ankle in the stance phase of the gait cycle, compared to barefoot walking on children with cerebral palsy. METHODS: A retrospective chart review of 2200 patients revealed that 71 patients (142 limbs) had a diagnosis of diplegia, with no contractures in hip, knee or ankle flexion. Their average age was 12.2 ± 3.9. All of them were wearing clinically prescribed hinged floor reaction ankle-foot orthosis undergoing a three dimensional gait analysis. We divided the patients in three groups: Group I, with limited extension (maximum knee extension less than 15°); Group II, with moderate limited extension (maximum knee extension between 15° and 30°) and Group III Crouch (maximum knee extension in stance more than 30°). RESULTS: Results indicate the parameters maximum knee extension and ankle dorsiflexion were significant in Group II e III; no change was observed in Group I. The maximum hip extension was not significant in all three groups. Conclusion: when indicated to improve the extension of the knees and ankle in the stance of the CP patients floor reaction ankle-foot orthosis was effective.

INTRODUÇÃO: A órtese de reação ao solo é freqüentemente prescrita com o objetivo de reduzir a flexão do joelho durante a fase de apoio na marcha de pacientes com paralisia cerebral. Não há informações suficientes relatadas na literature sobre este tipo de órteses. OBJETIVOS: O objetivo deste estudo foi determinar o efeito que a órtese de reação ao solo tem na cinamática angular das articulações do quadril, joelho e tornozelo durante a fase de apoio da marcha de crianças com paralisia cerebral, comparando a marcha descalça e com o uso das órteses MÉTODOS: Após um estudo retrospectivo de 2200 pacientes avaliados no laboratório de marcha, 71 pacientes com diagnóstico de paralisia cerebral do tipo diparesia espástica e idade média de 12.2 ± 3.9 foram selecionados (142 membros). Nenhum deles apresentou contratura em flexão dos quadris, joelhos e tornozelos. Todos usavam órteses do tipo reação ao solo articulada durante a avaliação da marcha. Os pacientes foram divididos em três grupos: Grupo I Extensão Limitada (pico de extensão do joelho menor que 15°); Grupo II Extenão Moderadamente Limitada (pico de extensão do joelho entre 15° e 30°) e Grupo III Agachamento (pico de extensão do joelho no apoio maior que 30°). RESULTADOS: Os resultados demostraram que o pico de extensão do joelho e o pico de dorsiflexão tiveram alterações significantes nos grupos II e III enquanto que o grupo I não apresentou alteração. O pico de extensão do quadril não mostrou alteração nos três grupos CONCLUSÃO: A órtese de reação ao solo é eficaz quando indicada para aumentar a extensão do joelho e tornozelo durante a fase de apoio da marcha de crianças com paralisia cerebral.

Evaluation of physiotherapy in the treatment of Legg-Calvé-Perthes disease / Avaliação do tratamento fisioterapêutico na doença de Legg-Calvé-Perthes

INTRODUCTION: Physiotherapy using muscle strengthening and stretching exercises is claimed to have beneficial effects in the treatment of Legg-Calvé-Perthes disease; however, no scientific evidence is available concerning effectiveness of treatment. PURPOSE: The purpose of the present study was to clinically evaluate possible effects of the proposed physiotherapeutic effects compared to observational follow-up in patients with Legg-Calvé-Perthes disease. METHOD: A prospective follow-up study was conducted in 17 patients with unilateral Legg-Calvé-Perthes disease, divided into 2 groups: Group A (observational follow-up) and Group B (physiotherapeutic follow-up). In order to evaluate the outcome of the adopted treatments, the following parameters were assessed: articular range of motion, level of muscular strength, level of articular dysfunction, and radiographic status, both before and after the treatment. RESULTS: Group B exhibited significant improvement in articular range of motion concerning hip flexion, extension, abduction, adduction, medial rotation, and lateral rotation, while in Group A an equally significant worsening occurred concerning abduction, adduction, and medial rotation. Muscular strength also improved in Group B, mainly in the set of hip flexor muscles, while Group A showed no changes. Articular dysfunction after therapy compared to pretherapy was significantly reduced in Group B and increased in Group A. Patients undergoing physiotherapy exercises showed no changes in their radiographic features. CONCLUSION: Physiotherapy produced significant improvement in articular range of motion, muscular strength, and articular dysfunction in patients with Legg-Calvé-Perthes disease, but these improvements were not evident on radiographs.

INTRODUÇÃO: A fisioterapia por meio de exercícios de fortalecimento e alongamento muscular é citada no tratamento de pacientes com doença de Legg-Calvé-Perthes; entretanto não há evidência científica sobre a efetividade do tratamento. OBJETIVO: O objetivo do trabalho foi avaliar clinicamente os possíveis efeitos dos exercícios fisioterapêuticos propostos em comparação com o acompanhamento observacional dos pacientes com doença de Legg-Calvé-Perthes. MÉTODO: Foi realizado um estudo prospectivo com 20 pacientes com doença de Legg-Calvé-Perthes unilateral, divididos em dois grupos: grupo A, acompanhamento observacional e grupo B, acompanhamento fisioterapêutico. Para avaliação dos resultados dos tratamentos adotados, foram avaliados os parâmetros: amplitude de movimento articular, grau de força muscular, grau de disfunção articular e quadro radiográfico, pré e pós-tratamento. RESULTADOS E DISCUSSÃO: Houve no grupo B uma melhora estatisticamente significativa da amplitude de movimento articular para a flexão, extensão, abdução, adução, rotação medial e rotação lateral do quadril, enquanto no grupo A ocorreu uma piora, também significativa, da abdução, adução e rotação medial. A força muscular também melhorou no grupo B, principalmente no grupo dos flexores quadril, enquanto no grupo A não houve alteração. O grau de disfunção articular apresentou, em média, uma melhora estatisticamente significativa no grupo B e uma piora no grupo A em relação aos períodos pré e pós-tratamento. Os pacientes submetidos aos exercícios fisioterapêuticos não apresentaram modificação do quadro radiográfico.

Osteoporosis among male Saudi Arabs: a pilot study

Little attention has been paid to the problem of male osteopororsis in Saudi Arabia. In this prospective study we assessed the prevalence of male osteoporosis among Saudi Arabs. We studied Saudi Arabian males > 50 years of age attending outpatient clinics at King Fahd Hospital of the University, AI-Khobar, between 1 May 2005 and 30 January 2006. We determined body mass index [BMI] and tests were done to rule out secondary osteoporosis. All subjects had a bone mineral density [BMD] measurement of the hip area and the lumbar spine using dual energy X-ray absorptiometry [DEXA]. A T-score of