Ultrasonographic findings in shoulders of able-bodied, paraplegic and tetraplegic subjects.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To evaluate the association between spinal cord injury (SCI) and ultrasonographic findings in shoulders. SETTING: Randomly selected patients of Käpylä Rehabilitation Centre and able-bodied citizens of Helsinki, Finland. METHODS: Ultrasonography of the shoulder was performed on able-bodied, tetraplegic and paraplegic subjects. Subjects with SCI were selected from patients of Käpylä Rehabilitation Centre, who were injured more than 3 months before the examination. RESULTS: Findings of the glenohumeral joint differed most clearly between the groups. Significant association between SCI level and oedema of the glenohumeral joint was noted in multiple regression analysis, where other background factors were also considered. CONCLUSION: Paraplegic and tetraplegic subjects are prone to glenohumeral changes that can be verified with ultrasonography.

Manipulation under anesthesia for frozen shoulder with and without steroid injection.

OBJECTIVE: To study the effect of manipulating a shoulder with adhesive capsulitis (frozen shoulder) under anesthesia with and without corticosteroid injection. DESIGN: Randomized trial. SETTING: Hospital. PARTICIPANTS: Twenty-four patients referred for manipulation of a frozen shoulder. INTERVENTION: The patients were randomized into 2 groups. One group received an injection of corticosteroid and manipulation; the other was only administered manipulation during anesthesia. MAIN OUTCOME MEASURES: The degree of shoulder mobility and pain before and after the manipulation. RESULTS: Manipulation under anesthesia increased the mobility of the affected shoulder. Injection with lidocaine and betamethason did not enhance the effect of the manipulation. CONCLUSION: Manipulation under anesthesia without intraarticular corticosteroids is recommended as the therapy for frozen shoulder.

Knee disorders in carpet and floor layers and painters. Part I. Isometric knee extension and flexion torques.

Knee morbidity, knee extension torque and knee flexion torque were examined among 168 actively working carpet and floor layers and 146 painters. The study included a questionnaire concerning knee disorders and knee symptoms, a clinical examination of the knees and measurement of isometric knee extension and flexion torque. Knee accidents were reported more frequently by carpet and floor layers than by painters. Tenderness of the knees was noted to an equal extent in the two groups. Knee extension torques gradually decreased by increasing age among carpet and floor layers, but not among painters. Body weight and thigh girth were not related to age among carpet and floor layers, but gradually increased with age among painters. Analysis of covariance showed that the torques were most consistently related to thigh girth and age. In addition, the right knee extension torque was related to occupation and tenderness of the patellofemoral joint; the left knee extension torque was related to the knee pain index. These results suggest that occupational kneeling and internal derangement of the knee affect thigh muscles among actively working house builders.

Knee disorders in carpet and floor layers and painters. Part II: Knee symptoms and patellofemoral indices.

One hundred and sixty-eight carpet and floor layers and 146 painters were examined with the aid of a questionnaire, clinical tests of the patellofemoral joint, a knee exertion test and measurements of patellofemoral indices. Carpet and floor layers reported previous knee conditions more frequently than painters. Patellofemoral tenderness was not related to occupation, patellofemoral indices or perceived knee conditions. On the contrary, pain in the knee exertion test of 50 squats was related to perceived knee injuries and pain on compression of the patella. Exertion test seems to be more accurate than traditional clinical tests in the screening of knee lesions.

Knee laxity in carpet and floor layers and painters.

The knees of 154 carpet and floor layers and 131 painters were examined clinically and the anteroposterior displacement of the knees was measured with a computer-based arthrometer. The drawer test, the pivot shift and the thigh muscle stretching tests showed greater mobility among carpet and floor layers than among painters. The arthrometric examination showed equal anteroposterior tibiofemoral displacements in the two groups. Two percent of the subjects had a right knee/left knee difference indicating a cruciate ligament insufficiency. Tightness in the rectus femoris stretching test, and among carpet and floor layers also radiographic tibiofemoral osteophytosis predicted small arthrometric changes.

Carpet-layer's knee. An ultrasonographic study.

In order to reveal abnormalities in the soft tissue of the anterior part of the knee, caused by protracted mechanical stress, we performed ultrasound studies of both knees of 95 male workers in the carpet-laying and parquet floor trade (group 1). Seventy-three painters (group 2) served as controls. In group 1, an anechoic fluid collection was detected in 10 knees, localized in the superficial infrapatellar bursa and in one patient in the prepatellar bursa, whereas there were no cases of fluid accumulation in the controls. A hypoechoic, oval subcutaneous thickening in the anterior wall of the superficial infrapatellar bursa was detected in 35 (18.4%) and 4 (2.7%) knees, respectively. Prepatellar subcutaneous thickening was detected in 45 knees (23.7%) in group 1, but in only 2 knees (1.4%) in group 2. Two knees in group 1 had thickened and inhomogeneous patellar tendons, while one in group 2 had a thickened and 2 both thickened and hypoechoic patellar tendons. We conclude that ultrasonography is a useful method for the detection of bursitis and soft tissue changes in carpet-layers. Detection of a fluid collection in a bursa does not necessarily denote bursitis of clinical importance, but does signify irritation due to work stress. Patellar tendon pathology is rare among carpet-layers and is probably unrelated to the occupation.

The MacIntosh lateral substitution reconstruction for anterior cruciate deficiency.

Twenty-five patients who had anterior cruciate deficient knees treated by the MacIntosh reconstruction operation were reviewed after 5 years, with particular reference to any changes occurring over time. Subjectively, the knees were improved and the results were even better after 5 years than after one year. This was considered to be due to a decrease in the restriction of flexion, and to the psychological and functional adaptation to the injured knee. In the knees operated on, the anterolateral instability increased significantly during the follow up from one year (mean 1.9 mm) to 5 years (3.0 mm), but the numerical value was still as good as in the intact knees (3.5 mm).

Occupationally related ultrasonic findings in carpet and floor layers' knees.

Soft-tissue changes in the anterior aspect of the knees were evaluated with ultrasonography among 96 randomly selected carpet and floor layers and 72 painters. The ultrasonography showed thickening of the prepatellar or superficial infrapatellar bursa in 49% of the carpet and floor layers and 7% of the house painters. Fluid collection in the prepatellar or superficial infrapatellar bursa was noted for 10 carpet and floor layers, and this ultrasonographic finding was associated with knee pain in kneeling postures.

Knee disorders in carpet and floor layers and painters.

In an evaluation of the effect of kneeling work on the knees, 168 actively working carpet and floor layers and 146 house painters were examined with the aid of a questionnaire, a clinical examination, and radiography. Reported knee pain, knee accidents, and treatment regimens for the knees were more common among the carpet and floor layers than among the painters. Radiographic changes of the tibiofemoral joint were noted equally in the two occupational groups, but osteophytes of the patella were more common among the carpet and floor layers than among the painters. In a multivariate analysis, the determinants of osteophytosis of the knee were age, occupation, knee accidents, and smoking, and osteophytosis may be due to more frequent workbreaks from kneeling postures among smoking workers. This study indicates that kneeling work increases the risk of knee disorders and such radiographic changes that might be an initial sign of knee degeneration.

A new method for protein crystallization using high pressure.

Crystallization methods for proteins have been the subject of decades of development yet protein crystallization remains the limiting step in structural studies. We present here a new method for protein crystallization--based on the use of high pressure--that enabled us to accelerate dramatically the growth of glucose isomerase crystals. We think this method may have a more general utility.