The Effects of Knee Pain on the Quadriceps Strength, Proprioception and Balance in Patients with Knee Osteoarthritis / 대한스포츠의학회지

The purpose of this study was to assess the effects of knee pain on the quadriceps strength, proprioception and balance in subjects with bilateral knee osteoarthritis and the correlation between muscle strength, proprioception, and balance in knee osteoarthritis patients with knee pain. The inclusion criteria were symptomatic and radiographic bilateral knee osteoarthritis (Kellgren-Lawrence grade > or =2), visual analogue scale difference of the both knees > or =2. Thirty three participants (32 women, 1 men: mean age, 59.18 years) underwent assessment of maximal voluntary contraction of quadriceps and hamstring muscles, knee proprioceptive acuity (measure passive joint reposition sense) and balance index using Biodex System 3 isokinetic dynamometer and Biodex balance System. In this study, the more pain knee had weaker quadriceps strength than less pain knee (p0.05). Poor proprioception was associated with low quadriceps strength and poor Medio-lateral Stability Index (p<0.05). Future studies needed to account the influence of pain on neuromuscular factors as well as attempt to further clarify the relationships between these factors.

The Effects of Knee Pain on the Quadriceps Strength, Proprioception and Balance in Patients with Knee Osteoarthritis / 대한스포츠의학회지

The purpose of this study was to assess the effects of knee pain on the quadriceps strength, proprioception and balance in subjects with bilateral knee osteoarthritis and the correlation between muscle strength, proprioception, and balance in knee osteoarthritis patients with knee pain. The inclusion criteria were symptomatic and radiographic bilateral knee osteoarthritis (Kellgren-Lawrence grade > or =2), visual analogue scale difference of the both knees > or =2. Thirty three participants (32 women, 1 men: mean age, 59.18 years) underwent assessment of maximal voluntary contraction of quadriceps and hamstring muscles, knee proprioceptive acuity (measure passive joint reposition sense) and balance index using Biodex System 3 isokinetic dynamometer and Biodex balance System. In this study, the more pain knee had weaker quadriceps strength than less pain knee (p0.05). Poor proprioception was associated with low quadriceps strength and poor Medio-lateral Stability Index (p<0.05). Future studies needed to account the influence of pain on neuromuscular factors as well as attempt to further clarify the relationships between these factors.

CYP2C9 Mutation Affecting the Individual Variability of Warfarin Dose Requirement

Warfarin is a frequently prescribed anticoagulant in rehabilitation patients. Adverse drug reactions of warfarin were reported as bleeding and cutaneous microvascular thrombosis. Major bleeding, such as intracranial hemorrhage and psoas hematoma, in patients receiving anticoagulation therapy is a rare condition, but sometimes very serious complication that can even be fatal. Patient-specific factors (eg, age, body size, race, concurrent diseases, and medications) explain some of the individual variability in warfarin dose, but genetic factors, which influence warfarin response, explain a significantly higher proportion of the variability in the dose. There are two identified genes that are responsible for the main proportion of the genetic effect: CYP2C9, which codes for the enzyme cytochrome P450 2C9 that metabolizes S-warfarin, and VKORC1, which codes for warfarin's target, vitamin K epoxide reductase. We report a case of intolerance to warfarin dosing, due to impaired drug metabolism in a patient with CYP2C9*1/*3 and VKORC 1173TT. Fortunately, there are no severe complications.

Clinical Usefulness of Schedule for Oral-Motor Assessment (SOMA) in Children with Dysphagia

OBJECTIVE: To investigate the clinical usefulness of the Schedule for Oral-Motor Assessment (SOMA) in children with dysphagia by comparing findings of SOMA with those of the videofluoroscopic swallowing study (VFSS). METHOD: Both SOMA and VFSS were performed in 33 children with dysphagia (21 boys and 12 girls; mean age 17.3+/-12.1 months) who were referred for oropharyngeal evaluation. Ratings of oral-motor functions indicated by SOMA were based upon the cutting score of each specific texture of food (puree, semi-solids, solids, cracker, liquid-bottle, and liquid-cup). Abnormalities of either the oral phase, or the pharyngeal phase as indicated by VFSS were assessed by a physician and a speech-language pathologist. RESULTS: There was significant consistency between the findings of SOMA and the oral phase evaluation by VFSS (Kappa=0.419, p=0.023). SOMA reached 87.5% sensitivity, 66.6% specificity, and 95.4% positive predictive value when compared with the oral phase of the VFSS. We were able to evaluate oral-motor function by using SOMA in 6 children who were unable to complete the oral phase evaluation by VFSS, due to fear and crying during the study. The findings of SOMA failed to show any consistency with the pharyngeal phase evaluation by VFSS (Kappa=-0.105, p=0.509). CONCLUSION: These results suggest that SOMA is a reliable method for evaluation of oral-motor function in children with dysphagia. In particular, SOMA is recommended for children that were unable to complete the oral phase evaluation by VFSS due to poor cooperation.

Clinical, Electrophysiological Findings in Adult Patients with Non-traumatic Plexopathies

OBJECTIVE: To ascertain the etiology of non-traumatic plexopathy and clarify the clinical, electrophysiological characteristics according to its etiology. METHOD: We performed a retrospective analysis of 63 non-traumatic plexopathy patients that had been diagnosed by nerve conduction studies (NCS) and needle electromyography (EMG). Clinical, electrophysiological, imaging findings were obtained from medical records. RESULTS: We identified 36 cases with brachial plexopathy (BP) and 27 cases with lumbosacral plexopathy (LSP). The causes of plexopathy were neoplastic (36.1%), thoracic outlet syndrome (TOS) (25.0%), radiation induced (16.7%), neuralgic amyotrophy (8.3%), perioperative (5.6%), unknown (8.3%) in BP, while neoplastic (59.3%), radiation induced (22.2%), neuralgic amyotrophy (7.4%), psoas muscle abscess (3.7%), and unknown (7.4%) in LSP. In neoplastic plexopathy, pain presented as the first symptom in most patients (82.8%), with the lower trunk of the brachial plexus predominantly involved. In radiation induced plexopathy (RIP), pain was a common initial symptom, but the proportion was smaller (50%), and predominant involvements of bilateral lumbosacral plexus and whole trunk of brachial or lumbosacral plexus were characteristic. Myokymic discharges were noted in 41.7% patients with RIP. Abnormal NCS finding in the medial antebrachial cutaneous nerve was the most sensitive to diagnose TOS. Neuralgic amyotrophy of the brachial plexus showed upper trunk involvement in all cases. CONCLUSION: By integrating anatomic, pathophysiologic knowledge with detailed clinical assessment and the results of ancillary studies, physicians can make an accurate diagnosis and prognosis.