Characteristics affecting cervical sagittal alignment in patients with chronic low back pain.

BACKGROUND: Sagittal spino-pelvic malalignment in patients with chronic low back pain (CLBP) have been reported in the past, which may also affect cervical spine lesions. The purpose of this study is to investigate the cervical alignment in patients with CLBP. METHOD: Of the patients who visited an orthopedic specialist due to low back pain lasting more than three months, 121 cases (average 71.5-years-old, 46 male and 75 female) with whole standing spinal screening radiographs were reviewed (CLBP group). Cervical parameters included cervical lordosis (CL), C2-C7 sagittal vertical axis (C2-7 SVA), and the T1 slope minus CL (T1S-CL). Cervical spine deformity was defined as C2-7 SVA >4 cm, CL <0°, or T1S-CL ≧20°. We compared the cervical alignment of these patients with 121 age and gender matched volunteers (control group). RESULTS: The prevalence of cervical spine deformity was significantly higher in the CLBP group than in the control group (20.7% vs. 10.7%, P = 0.034). The mean CL was smaller in the CLBP group than in the control group (16.1° vs. 21.4°, P = 0.002). The mean C2-7 SVA was 17.6 mm vs. 18.7 mm in the CLBP group and in the control group, respectively (P = 0.817). The mean T1S-CL was larger in the CLBP group than in the control group (9.1° vs. 3.5°, P < 0.001). Multivariate analysis showed that people with CLBP were more likely to have cervical deformities than people without CLBP (odds ratio 2.16, 95% confidence interval 1.006 to 4.637). CONCLUSIONS: This study results suggest that people with CLBP present with worse cervical sagittal alignment and higher prevalence of cervical spine deformities than age and gender matched volunteers with no CLBP. This means CLBP impacts cervical spine lesions negatively. LEVEL OF EVIDENCE: Ⅳ.

The Effect of Carpal Tunnel Release on Neuropathic Pain in Carpal Tunnel Syndrome.

PURPOSE: The aim of this study was to determine the risk factors of neuropathic pain (NP) in the patient with carpal tunnel syndrome (CTS) before and after the carpal tunnel release. MATERIALS AND METHODS: One hundred and two CTS patients were enrolled in the study. The pain score was measured by the visual analogue score. NP was determined by the painDETECT (PD) questionnaire. All subjects were divided into 3 groups at 12 weeks after surgery: an Improved, Unchanged, and Worsened group. The risk factors of worsening NP after surgery were evaluated. RESULTS: We found that 36% and 18% of patients with CTS had neuropathic pain before and 12 weeks after surgery, respectively, and pain was significantly stronger than in those without NP. The PD score of eight hands worsened after surgery. In the "Improved group," the average age at the surgery was younger and the pain score was lower than in the "Unchanged group." Conclusions. The surgery was very effective on NP of CTS; however, the PD in 7% of hands worsened after surgery. Risk factors before surgery that predicted worse NP after surgery were found to be a younger age, weaker pain, and the absence of night pain.

Histopathology of tenosynovium in trigger fingers.

Stenosing flexor tenosynovitis, trigger finger, is a common clinical disorder causing painful locking or contracture of the involved digits, and most instances are idiopathic. This problem is generally caused by a size mismatch between the swollen flexor tendon and the thickened first annular pulley. Although hypertrophic pulleys have been histologically and ultrasonographically detected, little is known about the histopathology of the tenosynovium covering the tendons of trigger fingers. We identified chondrocytoid cells that produced hyaluronic acid in 23 (61%) fingers and hypocellular collagen matrix in 32 (84%) fingers around the tenosynovium among 38 specimens of tenosynovium from patients with trigger fingers. These chondrocytoid cells expressed the synovial B cell marker CD44, but not the chondrocyte marker S-100 protein. The incidence of these findings was much higher than that of conventional findings of synovitis, such as inflammatory infiltrate (37%), increased vascularity (37%), hyperplasia of synovial lining cells (21%), or fibrin exudation (5%). We discovered the following distinctive histopathological features of trigger finger: hyaluronic acid-producing chondrocytoid cells originated from fibroblastic synovial B cells, and a hypocellular collagen matrix surrounding the tenosynovium. Thus, an edematous extracellular matrix with active hyaluronic acid synthesis might increase pressure under the pulley and contribute to the progression of stenosis.

Clinical characteristics of neuropathic pain in patients with carpal tunnel syndrome.

The purpose of this study was to identify the clinical characteristics of neuropathic pain in patients with carpal tunnel syndrome. We retrospectively reviewed 143 hands in 127 patients with carpal tunnel syndrome. The neuropathic pain was determined by using the painDETECT as a self-administered psychometric questionnaire to distinguish neuropathic pain. There were no significant differences in the characteristics of the patients with and without neuropathic pain. However, there were significant differences in the pain scores between those with and without neuropathic pain (p < 0.01). Furthermore, there was a significant difference between the existence of night pain in these patients (p < 0.01). Based on the results of the current study, we conclude that it is important to be aware of, and consider the existence of neuropathic pain during the treatment of patients with carpal tunnel syndrome with night pain or a high score on the numerical rating scales of pain.

The relationship between neuropathic pain, and the function of the upper limbs based on clinical severity according to electrophysiological studies in patients with carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve, and CTS can cause neuropathic pain. The aim of this study was to evaluate the relationship between neuropathic pain, function of the upper limb, and the electrophysiology in patients with CTS. The terminal latency of median nerve was measured in 34 patients diagnosed with CTS, and they were asked to fill out the Japanese Society for Surgery of the Hand version of the Disability of Arm, Shoulder, and Hand questionnaire (DASH-JSSH) as the patient's assessment of the function of upper limbs and pain DETECT as an assessment for neuropathic pain. There was no significant correlation between the terminal latency and the pain DETECT score, or the terminal latency and the DASH-JSSH score. However, there was a significant correlation between the pain DETECT and DASH-JSSH scores. Neuropathic pain affects the function of the upper extremities in patients with CTS.

Traumatic volar dislocation of the distal ulna with a fracture of the ulnar styloid.

Isolated volar dislocation of the distal ulna without forearm fracture is very rare; however, this injury is incorrectly diagnosed in approximately 50% of cases. This injury can lead to a significant functional disability if left untreated. This report presents a case of isolated volar dislocation of the distal ulna with an ulnar styloid fracture. The dislocation was subsequently reduced, the styloid was surgically repaired, and the patient was satisfied at the last follow-up. The importance of a proper clinical examination and an accurate radiographic position of the wrist are stressed. Furthermore, clinical evaluation of the distal radioular joint after reduction is important in achieving good results. There are various strategies for the treatment of distal radioulnar joint after reduction, including conservative treatment or surgical treatment. We believe that surgical exploration could have been carried out at an earlier stage had such a lesion been suspected. Additional case reports of other instances of successful treatment are needed to educate orthopaedic surgeons and emergency medical technicians on the nature of this type of injury.

Effect of exercise therapy on monocyte and neutrophil counts in overweight women.

INTRODUCTION: It has been well known that physical inactivity is associated with a significantly higher incidence of coronary artery disease. This study aimed to test our hypothesis that endurance aerobic exercise training has cardiovascular protective effects as a result of inhibiting inflammatory processes. METHODS: Forty-two overweight women [age, 53.4 +/- 9.8 years; body mass index (BMI), 28.0 +/- 2.8] received electric bicycle ergometer exercise therapy at the lactate threshold intensity for 30 to 60 minutes per day, 1 to 6 times per week for 6 weeks. The exercise training was performed within the possible load (exercise duration and frequency) for each subject. RESULTS: Leukocyte, monocyte, and neutrophil counts significantly decreased after the exercise therapy (P < 0.05). In simple regression analysis, percent changes in monocyte and neutrophil counts were correlated with percent changes in fasting triglyceride levels, insulin sensitivity index, BMI, and maximal oxygen uptake (VO2max). In stepwise multiple regression analysis, the percent change in monocyte counts was associated with percent changes in fasting triglyceride and VO2max (r = 0.368, P < 0.001), and the percent change in neutrophil counts was associated with percent changes in insulin sensitivity index and BMI (r = 0.292, P < 0.001). CONCLUSIONS: Endurance aerobic exercise training can influence some inflammatory processes. Furthermore, increased aerobic capacity may be antiinflammatory and have cardiovascular protective effects in overweight women.

Association between maximal oxygen uptake and the heart rate corrected-QT interval in postmenopausal overweight women.

BACKGROUND: Increased aerobic capacity can reduce the incidence of cardiovascular disease and the mortality rate. On the other hand, a prolonged heart rate corrected-QT (QTc) interval is associated with an increased risk of arrhythmias, cardiac sudden death and coronary artery disease. AIMS: The association of the aerobic capacity and coronary risk factors with QTc interval was investigated in postmenopausal overweight women. SUBJECTS AND METHODS: The subjects included 84 postmenopausal overweight women [age: 58.7+/-6.4 years, body mass index (BMI): 27.9+/-3.3] with coronary risk factors. Electrocardiogram (ECG) was recorded with a standard resting 12-lead ECG after more than 5 minutes of rest. The QTc interval was automatically calculated according to Bazett's formula. A multistage graded submaximal exercise test was performed on an electric bicycle ergometer to determine the estimated maximal oxygen uptake (VO(2)max). RESULTS: Single correlation analysis showed the QTc interval to be positively associated with hemoglobin A(1)c (HbA(1)c), fasting glucose, fasting insulin, BMI, waist circumference, serum potassium and the number of coronary risk factors, while negatively correlated with VO(2)max. Stepwise multiple regression analysis demonstrated the strong association of the QTc interval with HbA(1)c and VO(2)max (r(2)=0.244, p<0.0001). In both patients with and without metabolic syndrome (n=15, n=69, respectively), the QTc interval was independently associated with the HbA(1)c (r(2)=0.318, p<0.05, r(2)= 0.115, p<0.05, respectively). CONCLUSIONS: These results suggest that decreased aerobic capacity and glucose intolerance may be independent risk factors for a prolonged QTc interval, while demonstrating no relationship with metabolic syndrome.

Associations of monocytes, neutrophil count, and C-reactive protein with maximal oxygen uptake in overweight women.

BACKGROUND: Increased aerobic capacity can reduce the incidence of cardiovascular disease and mortality. Inflammation plays a pivotal role in the pathogenesis of atherosclerosis. AIMS: This study was designed to elucidate whether aerobic capacity is associated with inflammatory status. METHODS: The subjects included 90 overweight women [age, 51.5±10.7 yrs; body mass index (BMI), 28.1±2.5] with coronary risk factors who were outpatients at our institution. A multistage graded submaximal exercise stress test was performed on an electric bicycle ergometer to determine the estimated maximal oxygen uptake (VO(2) max). RESULTS: Univariate regression analyses showed that monocyte, neutrophil counts, and high sensitivity C-reactive protein (hs-CRP) levels were correlated with fasting triglycerides, fasting insulin, BMI, and waist circumference, while VO(2) max was negatively associated with monocyte and neutrophil counts, but not with hs-CRP. Stepwise multivariate regression analysis demonstrated a strong association of monocyte count with the fasting triglyceride and VO(2) max (r(2)=0.260, p<0.0001). Neutrophil count was also found to be associated with fasting triglyceride and fasting insulin (r(2)=0.114, p<0.0001), while hs-CRP was associated with fasting triglyceride and waist circumference (r(2)=0.151, p<0.0001). CONCLUSIONS: These results suggest that VO(2) max is a sensitive factor that reflects the inflammatory status and might support cardiovascular protective effects of aerobic exercise in overweight women.

Effects of low intensity exercise therapy on early phase insulin secretion in overweight subjects with impaired glucose tolerance and type 2 diabetes mellitus.

This study was designed to evaluate effects of exercise therapy on early phase insulin secretion in overweight subjects with impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM). The subjects consisted of overweight subjects with normal glucose tolerance (NGT, n=10), IGT (n=10) and DM (n=10) (age: 51.1+/-8.2, 56.3+/-8.8 and 58.5+/-6.2 years, respectively). All of these patients performed exercise therapy at lactate threshold intensity for 12 weeks. Before intervention, area under the glucose curve (AUC(PG)) was higher in DM, IGT and NGT groups, and area under the insulin curve (AUC(IRI)) and the early phase insulin secretion as calculated by insulinogenic index was higher in the NGT group than in either the IGT or DM groups (p<0.05). After exercise therapy, the insulin sensitivity, AUC(PG) and AUC(IRI) improved in three groups (p<0.05, respectively). The insulinogenic index increased in IGT and DM groups (p<0.05, respectively), but the changes in the insulinogenic index showed no significant differences between IGT and DM groups. These results suggest that the ss-cell function in subjects with IGT and DM could therefore improve after exercise therapy. Moreover, AUC(PG), AUC(IRI) and insulin sensitivity were also improved no relation to NGT, IGT and DM.

The possible influence of osteoarthritis of the knee on the accumulation of coronary risk factors in postmenopausal obese women.

OBJECTIVE: This cross-sectional study was designed to clarify the association between osteoarthritis of the knee (OAK) and coronary risk factors in postmenopausal obese women. SUBJECTS: The subjects consisted of 72 postmenopausal obese women (mean age 60.3 ± 7.6 years) with coronary risk factors. They were divided into two groups; including the OAK group and the normal knee (control) group. METHODS: Aerobic capacity was evaluated by maximal oxygen uptake (VO2 max) estimated from the nomogram of Åstrand and Ryhming. Daily activity was measured by a single-axis accelerometer. RESULTS: After adjusting for the age, the OAK group (n = 37) showed significantly higher obesity indices, the number of coronary risk factors, incidence of Metabolic Syndrome, a lower aerobic capacity and a lower daily activity than control group (n = 35). After adjusting for the age, body weight and body mass index, the OAK group with a high waist circumference, a low VO2 max and low mean total energy expenditure showed a significantly higher number of coronary risk factors than the control group with a low waist circumference, high VO2 max and high total energy expenditure. CONCLUSION: These results suggest that OAK was therefore associated with the aerobic capacity, daily activity and Metabolic Syndrome, and it may indirectly influence for the development of the future coronary heart disease in postmenopausal obese women.

Association between silent ST segment depression in exercise electrocardiography and insulin resistance in obese subjects.

OBJECTIVES: This study was designed to clarify the association between ST segment depression in exercise electrocardiography (ECG) and insulin resistance in obese subjects. METHODS: A multistage graded submaximal exercise stress test on the bicycle ergometer was performed under CM5-lead ECG monitoring in 114 obese subjects (39 men and 75 women, mean age 50.9 +/- 12.2 years, mean body mass index 28.6 +/- 3.1 kg/m(2)). RESULTS: In 27 patients showing ST segment depression at the final exercise intensities (abnormal ST), insulin resistance index by homeostasis model assessment (HOMA-IR) was higher and insulin sensitivity index was lower than in the remaining 87 patients with normal ST segment level (normal ST). The abnormal ST group showed significantly higher plasma glucose and serum insulin levels during the oral glucose tolerance test (OGTT) than the normal ST group. The abnormal ST group showed a significantly higher prevalence of hypertension, impaired glucose tolerance and metabolic syndrome than the normal ST group. Multiple logistic regression analysis showed that insulin resistance as evaluated by fasting insulin, sigma insulin during OGTT, HOMA-IR, insulin sensitivity index, the levels of uric acid, fasting glucose, systolic blood pressure and maximal oxygen uptake were independently associated with ST segment depression. CONCLUSIONS: These results suggest that insulin resistance may involve pathological ST depression during exercise, as well as previously reported factors such as hyperglycemia, hyperuricemia, hypertension and lower aerobic capacity.