Agreement between ultrasound-detected inflammation and clinical signs in ankles and feet joints in patients with rheumatoid arthritis / 北京大学学报(医学版)

OBJECTIVE@#To investigate the agreement between clinical signs (tenderness and/or swelling) in ankles and feet joints and ultrasound findings in patients with rheumatoid arthritis (RA).@*METHODS@#RA patients with at least 1 tender and/or swollen joint in bilateral ankles and metatarsophalangeal (MTP) joints detected by physical examination were enrolled and underwent ultrasound examination by greyscale (GS) and power Doppler (PD) mode. The agreement between clinical signs and ultrasound-detected inflammation (joint effusion, synovitis, or tenosynovitis) was analyzed.@*RESULTS@#In the study, 113 consecutive RA patients were included, with mean age of (52.5±12.6) years, median duration of 60 (13, 129) months, mean disease activity score in 28 joints based on erythrocyte sedimentation rate [DAS28 (ESR)] of 5.1±1.7, mean disease activity score in 28 joints based on C reactive protein[DAS28 (CRP)]of 4.6±1.5. The tenderness and swelling was most commonly detected in ankles (52.7% and 31.9%, respectively), while GS (+) synovitis was most frequently detectable in MTP2 (34.1%), followed by ankles (32.7%) and MTP1 (27.9%), and PD (+) synovitis was most frequently detectable in MTP1 (14.2%), followed by ankles (12.4%) and MTP2 (10.6%). The prevalence of tenosynovitis was 41.1%, which mostly located in tibialis posterior tendon (22.1% of GS positive and 17.6% of PD positive). The highest prevalence of joint effusion was detected in ankles (9.7%), while that of bone erosion in MTP5 (19%). The overall concordance rate between positive clinical signs and ultrasound-determined joint inflammation was poor in the above joints (κ < 0.2, P < 0.05), in which swelling had the highest κ coefficient with ultrasound-determined joint inflammation in ankles (κ=0.225, P < 0.05). Moreover, swelling had the highest κ coefficient with synovitis in ankles (κ=0.231, P < 0.05).The concordance between tenosynovitis and signs in ankles was also poor (κ < 0.20, P < 0.05). There was no significant agreement between joint effusion and clinical signs (P > 0.05).@*CONCLUSION@#The overall concordance between clinical signs and inflammation on ultrasound was poor in ankles and feet joints. Tenderness and swelling was more common in ankles, while more lesions were detected by ultrasound at MTP joints. Ultrasound is useful in assessing the lesions besides physical examination in patients with RA.

Effects of botulinum toxin type A injection on the walking ability of stroke survivors with spastic foot drop and talipes varus / 中华物理医学与康复杂志

Objective To observe the effect of injecting botulinum toxin type A ( BTX-A) into the tibialis anterior muscle on spasm and the walking function of stroke survivors with spastic foot drop and strephenopodia. Methods Fifty-six stroke survivors with spastic foot drop and strephenopodia were randomly divided into a tibialis anterior injection group ( Group TA) and a conventional injection group ( Group CG) , each of 28. Both groups had 50 U of BTX-A injected into the medial-lateral heads of the affected gastrocnemius and soleus muscles, and 35 U in-jected into each of two sites in the tibialis posterior. Group TA was additionally injected with 30 U in the tibialis ante-rior. Before the injection, as well as 2, 4 and 12 weeks afterward, both groups were evaluated using the modified Ashworth scale (MAS) for the plantar flexors and varus muscle groups, a 10-minute walking test (10 m-WT), a simple Fugl-Meyer assessment ( FMA) of the lower limb and a timed up and go test ( TUG) . Results Before the injection, there were no statistically significant differences in the average MAS, 10 m-WT, FMA or TUG results be-tween the two groups. After 2 weeks, however, the average MAS score of both groups had decreased significantly, and that improvement was maintained at 4 and 12 weeks after the injection. Moreover, 2, 4 and 12 weeks after the injec-tion, significant differences in the average MAS score were observed between the two groups. The average 10m-WT re-sults, FMA scores and TUG times of both groups also improved significantly, but there were significant differences between the two groups′10m-WT times and FMA scores after 2 and 4 weeks. Conclusions Injecting a small dose of BTX-A into the tibialis anterior can further relieve spasm in the tibialis anterior muscle and improve the walking a-bility of stroke survivors with spastic foot drop and strephenopodia.

Proprioceptive neuromuscular facilitation combined with core stability training can help relieve functional ankle instability / 中华物理医学与康复杂志

Objective To observe the effect of proprioceptive neuromuscular facilitation (PNF) technology combined with core stability training on the rehabilitation of patients with functional ankle instability (FAI).Methods Twenty FAI patients were randomly divided into an experimental group and a control group,each of 10.The control group was given routine rehabilitation together with ankle strengthening training and proprioception training.The experimental group was provided with PNF combined with core stability training in addition to the routine rehabilitation.Before and after the 12 training sessions,both groups were evaluated using the Cumberland ankle instability tool (CAIT).The strength of their ankle flexors and extensors was measured in isokinetic concentric contraction,ankle proprioception was tested and the star excursion balance test (SEBT) was administered.Results Before the intervention there were no significant inter-group differences in any of the measurements.Afterward,significant improvements were observed in the first three tests,with the experimental group's average improvement significantly better than that of the control group.All of the SEBT measurements were significantly better than before the treatment,with significant differences between the two groups in the posterolateral,posterior,posteromedial,medial and anteromedial directions.Conclusion PNF technology combined with core stability training can improve ankle strength and proprioception and the dynamic balance of FAI patients.

Closed reduction and open reduction and internal fixation for the treatment of postoperative joint not-re-set therapeutic effects analysis in the comminuted double ankle fracture / 中国综合临床

Objective To investigate the postoperative joint not?reset therapeutic effects in the commi?nuted double ankle fracture. Methods From August 2012 to February 2015 in Dongfeng Hospital Affiliated to Hubei Medical College,72 comminuted double ankle fracture postoperative joint not?reset patients were selected as the study subjects,and according to the order of admission were equally divided into the treatment group and the control group,36 patients of each group. The treatment group were treated with closed reduction internal fixa?tion,the control group were given the open reduction and internal fixation. The intraoperative and postoperative recovery of both groups were observed. Results All the operation were completed successfully, the operative time,blood loss and postoperative hospital stay in the treatment group were ( 89. 24 ± 10. 34 ) min, ( 67. 24 ±14. 87) ml and (11. 45±2. 34) d respectively,significantly less than the control group((123. 45±11. 98) min,(82. 14±13. 45) ml and (14. 98±2. 47) d),the differences were significant(t=6. 498,4. 988,5. 278,P<0. 05) . The postoperative 3 months ankle function excellent in the treatment group and the control group were 94. 4%(34/36) and 77. 8%(28/36) respectively,the differences was significant(χ2=5. 966,P<0. 05). The postoperative 3 months pain scores in the treatment group and control group were 1. 78 ± 0. 45 points and 2. 60 ±0. 44 points,the differences was significant(t=8. 355,P<0. 05),and significantly lower than the preoperative ((6. 44±0. 67) points, (6. 49±0. 40) points),the differences were significant(t=25. 983,17. 332,P<0. 05) . Conclusion The closed reduction internal fixation for the postoperative joint not?reset therapeutic in the com?minuted double ankle fracture has better minimally invasive,it can promote double ankle function recovery and relieve pain,it is a reliable way of clinical applications.

Exploración ecográfica al pie de patinadores / Echographic screening in the skater's foot

INTRODUCCIËN: La confluencia de factores que provocan la fricción del patín sobre ciertas áreas de los pies de patinadores durante sus entrenamientos ocasiona lesiones nodulares. OBJETIVO: Explorar y describir características imagenológicas de estas excrecencias circunscritas que se presentan en los pies de patinadores como consecuencia del sobreuso deportivo. MÉTODOS: Se realizó estudio transversal y descriptivo en 100 jóvenes masculinos no deportistas (controles) y en los 15 integrantes de la Preselección Cubana de Patinaje de carrera en abril de 2009 (10 varones y 5 hembras), todos con más de diez años de práctica deportiva sistemática. Se les realizó examen ecográfico diagnóstico en el Instituto de Medicina Deportiva para evaluar el estado de las estructuras articulares y periarticulares de esta región y los datos se procesaron mediante estadística descriptiva. RESULTADOS: Se verificaron distorsiones ecográficas en el 100 por ciento de los deportistas evaluados caracterizadas fundamentalmente por: engrosamiento dérmico circunscrito (100 por ciento), tendinitis (33,3 por ciento) y exostosis bursata (20 por ciento); manifestaciones todas incluidas en una afección que los autores identificaron como el pie del patinador cuya expresión clínica externa lo constituye la presencia de nódulos de localización retrocalcánea, región dorsal y/o medial del pie. CONCLUSIONES: El pie del patinador puede constituir una entidad nosológica que tiene sustento imagenológico y que se relaciona con la fricción directa y sistemática del patín, propia de este deporte y que no solo afecta la piel de los pies de los patinadores sino que puede interferir con el entrenamiento o competencia por la asociación con otras lesiones

INTRODUCTION: The convergence of factors leading to skate friction on some areas of skater's feet during trainings provoke nodular injuries. OBJECTIVES: To explore and to describe the imaging features of these circumscribed excrecences present in the skater's feet as consequence of sports overuse. METHODS: A cross-sectional and descriptive study was conducted in 100 young no-sportsmen (controls) and in the 15 members of the Cuban Pre-Selection of speed Skating in April, 2009 (10 boys and 5 girls), all of them with more than 10 years of systematic sports practice. Then underwent a diagnostic echographic examination in the Institute of Sports Medicine to assess the condition of articular and periarticular structures of this area and data were processed by descriptive statistics. RESULTS: There were demonstrated echographic distortions in 100 percent of assessed sportsmen, mainly due to: circumscribed dermic thickening (100 percent), tendonitis (33,3 percent) and exostosis bursata (20 percent), manifestations included in an affection identified by authors as skater foot whose external clinical expression is the presence of retrocalcaneal nodules, dorsal and/or foot medial region. CONCLUSIONS: The skater's foot may be a disease entity with an imaging support and is related to direct and systematic friction of skate, characteristic of this sport and that not only involve the teeth's skin but it may to interfere with treatment or competence due to its association with other injuries